Caregiver Enhanced Assistance and Support for the Elderly Heart Failure Patient at Hospital Discharge (CEASE-HF) (CEASE-HF)

This is an interventional supportive care trial for Heart Failure focused on measuring Heart failure, Heart diseases, Cardiovascular diseases, Health information technology, Disease management, Patient care management, Self care, Informal caregiver, Care partner, Peer support, Transitional care, Patient education, Teach-back, Clinical decision aid Read More

Inclusion Criteria:

• Primary diagnosis of Heart Failure (with preserved or impaired left ventricular systolic dysfunction) confirmed with the Boston Criteria >= 5 points
• 60 years of age or older

Exclusion Criteria:

• Residence in, or planned discharge to a long-term care facility (LTC)
• Life expectancy less than 3 months
• Patient transferred to Geriatric Rehabilitation unit
• No caregiver
• Residence is more than a 30 minute rive from hospital of discharge
• Patient refused to participate
• Caregiver refused to participate
• Patient referred for CV surgery prior to hospital discharge
• Patient on IV Lasix at or bumetamide at hospital discharge
• Not on PO Lasix at hospital discharge
• Patient currently on dialysis
• Caregiver unavailable during daytime hours
• Caregiver has disability, serious mental illness or cognitive dysfunction
• Patient discharged early
• Patient enrolled in another randomized controlled trial
• Patient expired
• Patient and caregiver unable to speak and read English (Patient may be enrolled if nurse can converse minimally with patient and caregiver. S-TOFHLA will not be done for reading comprehension and questionnaires will be administered orally.)
• Severe aortic stenosis or severe mitral stenosis