Implementation of guideline-directed management for heart failure (HF) in primary care can be challenging despite established evidence-based recommendations. This randomized controlled trial published in the ESC Heart Failure assessed whether a structured transitional care intervention improved adherence to recommended therapies following hospitalization for HF.
Patients hospitalized with HF were randomized 1:1 to intervention or usual care. The intervention included inpatient guideline-based education, a post-discharge plan with referral to cardiac rehabilitation, scheduled general practitioner follow-ups at 1 and 4 weeks and 3 months, and a cardiologist-approved medication titration plan. The control group received usual care. 

The primary outcome, measured at 6 months, was adherence to five recommended treatments: angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor–neprilysin inhibitor (ARNI) at ≥50% target dose, beta blocker at ≥50% target dose, mineralocorticoid receptor antagonist at any dose, anticoagulation for atrial fibrillation, and cardiac rehabilitation referral.

Among 225 participants (25% female), 61.8% in the intervention group achieved the primary outcome compared with 28.7% in the control group (p<0.01). The unadjusted odds ratio indicated the intervention group was 6.27 times more likely to achieve the composite outcome (95% CI 3.35-11.76; p<0.01). Differences were driven by higher prescription rates of ACEI/ARB/ARNI and beta blockers and greater referral to cardiac rehabilitation.

Hospital-based transitional support improved adherence to guideline-recommended HF care in primary practice. Broader implementation of such processes has the potential to improve clinical outcomes for patients with HF.