More COACHing Needed to Optimize Care after Heart Failure Hospitalization

This editorial reviews the COACH trial, a stepped-wedge, cluster-randomized study involving over 5000 patients from 10 Ontario hospitals, which tested a risk-stratified protocol for heart failure discharge planning. Patients were assigned to hospitalization or early outpatient follow-up based on validated risk scores. The intervention reduced death and cardiovascular hospitalizations at both 30 days and 20 months, especially among low-risk patients (via rapid follow-up) and high-risk patients (via appropriate hospitalization). However, the editorial cautions that the impact on noncardiovascular readmissions remains unclear. It advocates for multidomain post-discharge strategies including medication reconciliation, cognitive and functional support, social services, and remote monitoring. Training for clinicians managing rapid follow-up and mobile-health tools may further optimize care. The authors call for nuanced algorithms to address the complexities of heart failure management and postdischarge outcomes.

This editorial reviews the COACH trial, a stepped-wedge, cluster-randomized study involving over 5000 patients from 10 Ontario hospitals, which tested a risk-stratified protocol for heart failure discharge planning. Patients were assigned to hospitalization or early outpatient follow-up based on validated risk scores. The intervention reduced death and cardiovascular hospitalizations at both 30 days and 20 months, especially among low-risk patients (via rapid follow-up) and high-risk patients (via appropriate hospitalization). However, the editorial cautions that the impact on noncardiovascular readmissions remains unclear. It advocates for multidomain post-discharge strategies including medication reconciliation, cognitive and functional support, social services, and remote monitoring. Training for clinicians managing rapid follow-up and mobile-health tools may further optimize care. The authors call for nuanced algorithms to address the complexities of heart failure management and postdischarge outcomes.