Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failure

Abstract Background Chronic Heart Failure (CHF) is a complex clinical syndrome that occurs in the end stages of various cardiovascular diseases. It is characterized by symptoms such as weakness, reduced cardiac function, and decreased exercise capacity. The high incidence, high mortality rate, and p...

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Main Authors: Zhi-Fen Feng, Yun Liu, Jordan Tovera Salvador, Minerva Bravo De Ala, Mary Ann Cabansag Nery, Xin-Yue Huang, Lei Zhang, Shan Liu
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Nursing
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Online Access:https://doi.org/10.1186/s12912-025-03447-5
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author Zhi-Fen Feng
Yun Liu
Jordan Tovera Salvador
Minerva Bravo De Ala
Mary Ann Cabansag Nery
Xin-Yue Huang
Lei Zhang
Shan Liu
author_facet Zhi-Fen Feng
Yun Liu
Jordan Tovera Salvador
Minerva Bravo De Ala
Mary Ann Cabansag Nery
Xin-Yue Huang
Lei Zhang
Shan Liu
author_sort Zhi-Fen Feng
collection DOAJ
description Abstract Background Chronic Heart Failure (CHF) is a complex clinical syndrome that occurs in the end stages of various cardiovascular diseases. It is characterized by symptoms such as weakness, reduced cardiac function, and decreased exercise capacity. The high incidence, high mortality rate, and poor prognosis of CHF have become prominent features of this disease, making it an urgent and pressing clinical issue. Aim This study aims to investigate the impact and evaluate the effectiveness of hospital-to-home transitional care for patients with chronic heart failure (CHF). Methods Convenient sampling was used to select 60 patients with CHF from the cardiology department of a tertiary Grade A hospital in Guangdong Province between February and June 2022. The patients were divided into a control group and an intervention group using a random number table, with 30 patients in each group. The intervention group received a transitional care intervention mainly focused on the transitional care model (TCM), while the control group received routine treatment and interventions for CHF. Results The intervention group showed significantly higher levels of self-efficacy and self-management and better cardiac ultrasound examination results than the control group (P < 0.05). The intervention group also had lower scores in laboratory indicators (plasma NT-pro BNP) than the control group (P < 0.05). Hospital readmission rate: There was no significant difference in hospital readmission rates between the two groups (P > 0.05), but the intervention group showed a significant difference in emergency admission rate (P < 0.05). Conclusions The hospital-to-home TCM enhances self-management and improves the quality of life for patients with chronic heart failure. The conduct of this research provides clinical practitioners with reference for later research, and is also conducive to the promotion and popularisation of health care policies. This study has registered the ethical review batch number, which is NCT06779227. Trial registration The trial has been registered on ClinicalTrial.gov (Ref: NCT06779227). The registration date is January 15, 2025.
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spelling doaj-art-ff6b567b992d46e9a7a3fcb9b3c1a5cd2025-08-20T03:03:24ZengBMCBMC Nursing1472-69552025-07-0124111310.1186/s12912-025-03447-5Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failureZhi-Fen Feng0Yun Liu1Jordan Tovera Salvador2Minerva Bravo De Ala3Mary Ann Cabansag Nery4Xin-Yue Huang5Lei Zhang6Shan Liu7School of Nursing and Health, Henan UniversityZhongshan People’s Hospital Nursing DepartmentNursing Education Department, College of Nursing, Imam Abdulrahman Bin Faisal UniversitySchool of Nursing, Philippine Women’s UniversitySchool of Nursing, Philippine Women’s UniversitySchool of Nursing and Health, Henan UniversitySchool of Nursing and Health, Henan UniversitySchool of Nursing and Health, Henan UniversityAbstract Background Chronic Heart Failure (CHF) is a complex clinical syndrome that occurs in the end stages of various cardiovascular diseases. It is characterized by symptoms such as weakness, reduced cardiac function, and decreased exercise capacity. The high incidence, high mortality rate, and poor prognosis of CHF have become prominent features of this disease, making it an urgent and pressing clinical issue. Aim This study aims to investigate the impact and evaluate the effectiveness of hospital-to-home transitional care for patients with chronic heart failure (CHF). Methods Convenient sampling was used to select 60 patients with CHF from the cardiology department of a tertiary Grade A hospital in Guangdong Province between February and June 2022. The patients were divided into a control group and an intervention group using a random number table, with 30 patients in each group. The intervention group received a transitional care intervention mainly focused on the transitional care model (TCM), while the control group received routine treatment and interventions for CHF. Results The intervention group showed significantly higher levels of self-efficacy and self-management and better cardiac ultrasound examination results than the control group (P < 0.05). The intervention group also had lower scores in laboratory indicators (plasma NT-pro BNP) than the control group (P < 0.05). Hospital readmission rate: There was no significant difference in hospital readmission rates between the two groups (P > 0.05), but the intervention group showed a significant difference in emergency admission rate (P < 0.05). Conclusions The hospital-to-home TCM enhances self-management and improves the quality of life for patients with chronic heart failure. The conduct of this research provides clinical practitioners with reference for later research, and is also conducive to the promotion and popularisation of health care policies. This study has registered the ethical review batch number, which is NCT06779227. Trial registration The trial has been registered on ClinicalTrial.gov (Ref: NCT06779227). The registration date is January 15, 2025.https://doi.org/10.1186/s12912-025-03447-5ChinaChronic diseaseHeart failureHome care services
spellingShingle Zhi-Fen Feng
Yun Liu
Jordan Tovera Salvador
Minerva Bravo De Ala
Mary Ann Cabansag Nery
Xin-Yue Huang
Lei Zhang
Shan Liu
Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failure
BMC Nursing
China
Chronic disease
Heart failure
Home care services
title Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failure
title_full Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failure
title_fullStr Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failure
title_full_unstemmed Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failure
title_short Implementation and evaluation of hospital-to-home transitional care intervention in patients with chronic heart failure
title_sort implementation and evaluation of hospital to home transitional care intervention in patients with chronic heart failure
topic China
Chronic disease
Heart failure
Home care services
url https://doi.org/10.1186/s12912-025-03447-5
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