Heart Failure Disease Management Program Research Articles

Implementation of a heart failure disease management program in the rural southern United States: a best practice implementation project.

Heart failure affects thousands of patients annually, often resulting in hospitalization, emergency room visits, and decreased quality of life. The scientific evidence indicates that disease management programs using a multidisciplinary approach improve outcomes for heart failure patients. The overarching aim of this evidence implementation project was to establish a disease management program for heart failure patients. Specifically, the project sought to promote compliance with best practices for the early identification of heart failure exacerbation symptoms to prevent emergency room visits and hospitalizations, thereby reducing morbidity and mortality. This project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted, revealing the need for a heart failure disease management program. A policy was developed to implement a disease management program and virtual relationships were established to create a multidisciplinary team. A follow-up audit was conducted to determine whether the implemented interventions closed the gap in practice identified by the baseline audit. The baseline audit revealed 0% compliance with best practices for the management of patients with heart failure, while the follow-up audit revealed 93.3% compliance. This project enhanced best practices by implementing a protocol in a rural health clinic to ensure that all heart failure patients were enrolled in a disease management program. Recommendations include using the electronic health record to quickly identify heart failure patients and their status in a disease management program. Chart audits should be performed every 6 months to ensure the program's sustainability and to determine heart failure patients' enrollment status. http://links.lww.com/IJEBH/A270.

Randomised pilot study comparing a coach to SMARTPhone reminders to aid the management of heart failure (HF) patients: humans or machines

Ambulatory management of congestive heart failure (HF) continues to be a challenging clinical problem. Recent studies have focused on the role of HF clinics, nurse practitioners and disease management programmes...

Reduced Heart Failure 30-day Readmission With Implementation Of A Cohesive And Structured Nurse Practitioner Led Inpatient And Outpatient Heart Failure Disease Management Program

Reduced Heart Failure 30-day Readmission With Implementation Of A Cohesive And Structured Nurse Practitioner Led Inpatient And Outpatient Heart Failure Disease Management Program

Heart Failure Disease Management Program Decreases 30-day Re-admissions & Improves Heart Failure Quality Metrics

Heart Failure Disease Management Program Decreases 30-day Re-admissions & Improves Heart Failure Quality Metrics

EE458 Benefits, Costs and Cost Effectiveness of a Chronic Heart Failure Disease Management Program for Austria – a Decision-Analytic Modeling Study

EE458 Benefits, Costs and Cost Effectiveness of a Chronic Heart Failure Disease Management Program for Austria – a Decision-Analytic Modeling Study

Benefits and challenges of telemedicine for heart failure consultations: a qualitative study

BackgroundPrior to the Covid-19 pandemic, heart failure (HF) disease management programmes were predominantly delivered in-person, with telemedicine being uncommon. Covid-19 resulted in a rapid shift to “remote-by-default” clinic appointments in many organisations. We evaluated clinician and patient experiences of teleconsultations for HF.MethodsFrom 16th March 2020, all HF appointments at a specialist centre in the UK were telemedicine-by-default through a mixture of telephone and video consultations, with rare in-person appointments. HF clinicians and patients with HF were invited to participate in semi-structured interviews about their experiences. A purposive sampling technique was used. Interviews were conducted using Microsoft Teams®, recorded and transcribed verbatim. Narrative data were explored by thematic analysis. Clinicians and patients were interviewed until themes saturated.ResultsEight clinicians and eight patients with HF were interviewed before themes saturated. Five overarching themes emerged: 1) Time utilisation – telemedicine consultations saved patients time travelling to and waiting for appointments. Clinicians perceived them to be more efficient, but more administrative time was involved. 2) Clinical assessment – without physical examination, clinicians relied more on history, observations and test results; video calls were perceived as superior to telephone calls for remote assessment. Patients confident in self-monitoring tended to be more comfortable with telemedicine. 3) Communication and rapport – clinicians experienced difficulty establishing rapport with new patients by telephone, though video was better. Patients generally did not perceive that remote consultation affected their rapport with clinicians. 4) Technology – connection issues occasionally disrupted video consultations, but overall patients and clinicians found the technology easy to use. 5) Choice and flexibility – both patients and clinicians believed that the choice of modality should be situation-dependent.ConclusionsTelemedicine HF consultations were more convenient for patients, saved them time, and were generally acceptable to clinicians, but changed workflows, consultation dynamics, and how clinical assessment was performed. Telemedicine should be used alongside in-person appointments in a “hybrid” model tailored to individual patients and settings.

The effect of tablet computer-based telemonitoring added to an established telephone disease management program on heart failure hospitalizations: The Specialized Primary and Networked Care in Heart Failure (SPAN-CHF) III Randomized Controlled Trial

BackgroundMobile health applications are becoming increasingly common. Prior work has demonstrated reduced heart failure (HF) hospitalizations with HF disease management programs; however, few of these programs have used tablet computer-based technology. MethodsParticipants with a diagnosis of HF and at least 1 high risk feature for hospitalization were randomized to either an established telephone-based disease management program or the same disease management program with the addition of remote monitoring of weight, blood pressure, heart rate and symptoms via a tablet computer for 90 days. The primary endpoint was the number of days hospitalized for HF assessed at 90 days. ResultsFrom August 2014 to April 2019, 212 participants from 3 hospitals in Massachusetts were randomized 3:1 to telemonitoring-based HF disease management (n = 159) or telephone-based HF disease management (n = 53) with 98% of individuals in both study groups completing the 90 days of follow-up. There was no significant difference in the number of days hospitalized for HF between the telemonitoring disease management group (0.88 ± 3.28 days per patient-90 days) and the telephone-based disease management group (1.00 ± 2.97 days per patient-90 days); incidence rate ratio 0.82 (95% confidence interval, 0.43-1.58; P = .442). ConclusionsThe addition of tablet-based telemonitoring to an established HF telephone-based disease management program did not reduce HF hospitalizations; however, study power was limited

Heart failure disease management program: A review.

Disease management programs (DMPs) have shown great potential for optimizing care of chronically ill patients, thereby improving health outcomes and patient satisfaction. This had led to an overall reduction in healthcare costs. Longer life expectancy has led to increased utilization of healthcare facilities, which may lead to a rise in costs. DMPs are an effective means of improving care and compliance and ultimately curbing inappropriate resource utilization. The present study reviews different definitions proposed for disease management, its components, the evidence behind it, and the conditions for success. It also examines heart failure management as an example of a DMP, exploring the complexity surrounding implementation of guideline-based approaches in patient care. A literature search on DMPs was conducted using PubMed, MEDLINE, and Google Scholar, including heart failure management programs from articles published from 2000 to 2020. This reviewed emphasized on the management of important biomarkers and cardiovascular indicators such as glycemic levels, urine output to improve efficacy of disease management programme during patient treatment.The review concluded that diseases like heart failure can be combat by improving the quality of care for patients and reducing the burden on the public healthcare system. Moreover, DMPs have proved to be an effective way of improving care and compliance with treatment.

A demographic study to profile non-attenders at a single centre heart failure outpatient clinic

Abstract Funding Acknowledgements Type of funding sources: None. Background Nonattendance is a source of inefficiency increasing waiting lists with potential secondary effects on the health status of non-attenders. This is true for patients in heart failure (HF) management programmes with nonattendance reducing the opportunity for prevention intervention &potentially increasing the risk of HF re-hospitalisation. Methods A retrospective analysis of trends of non-attendance of appointments to a single centre HF disease management programme over 36 months. Variables which influence missed appointments such as day of week & comparison between the first & second 6 months of the year were analysed. Patients who did not attend (DNA) their HF appointments (index cases) over 12 months (January–December 2021) were compared with a sample of patients who attended the same clinics (using a computer-generated randomisation technique). Variables which influence missed appointments were compared (age, gender, new/return status, history of cognitive impairment, non-English speaker, HF type, aetiology of cardiomyopathy, recent HF hospitalisation/need for IV diuretics & disease burden measured by NYHA Classification, NTproBNP & No. of comorbid conditions). Results In the 36 months studied there were 460 non-attenders (DNA rate 7.9%) out of 5,823 appointments. The DNA rate did not differ based on day of appointment (p=0.091)/ between the first & second halves of the year (p=0.059). 138 DNA's were compared with 138 controls who attended the same HF service over a 12-month period in 2021. Mean LVEF was similar between index (35.2%) &control cases (35.2%), NTproBNP did not differ significantly (2306 vs 2365) & no. of comborbid conditions did not differ significantly between groups (7 +/- 2.7 vs 6.8 +/-2.6). DNA's had a higher NYHA class than attenders (p=0.02). Measures of disease burden-recent HF hospitalisation/need for IV diuretics, NTproBNP & no. of comorbid conditions did not show statistical difference between index &control groups. There was a trend towards non-English-speaking patients & new referrals not attending appointments compared to the control group, however this did not reach statistical significance (p=0.06). Comparison of other variables such as gender, history of cognitive impairment/dementia, HF type, aetiology of cardiomyopathy did not influence attendance. (Table 1). Conclusion(s) Nonattendance to a HF management programme remained static annually with a mean DNA rate of 7.9% over the 3-year period studied. The present study did not identify any statistically significant clinical factors that influenced nonattendance, though there was a trend towards higher default rate for new patients & non-English speaking patients. NYHA class was higher in non-attenders than attenders though other indirect measures of disease burden did not influence attendance. Non clinical factors should be further studied to identify factors which influence nonattendance in order to develop strategies to minimise non-attendance

A Randomized Controlled Trial of Heart Failure Disease Management in Skilled Nursing Facilities.

Patients discharged from the hospital to a skilled nursing facility (SNF) are not typically part of a heart failure disease management program (HF-DMP). The objective of this study is to determine if an HF-DMP in SNF improves outcomes for patients with HF. Cluster-randomized controlled trial. The trial was conducted in 47 SNFs, and 671 patients were enrolled (329 HF-DMP; 342 to usual care). The HF-DMP included documentation of ejection fraction, symptoms, weights, diet, medication optimization, education, and 7-day visit post SNF discharge. The composite outcome was all-cause hospitalization, emergency department visits, or mortality at 60days. Secondary outcomes included the composite endpoint at 30days, change in the Kansas City Cardiomyopathy Questionnaire and the Self-care of HF Index at 60days. Rehospitalization and mortality rates were calculated as an exploratory outcome. Mean age of the patients was 79 ± 10years, 58% were women, and the mean ejection fraction was 51% ± 16%. At 30 and 60days post SNF admission, the composite endpoint was not significant between DMP (29%) and usual care (32%) at 30days and 60days (43% vs 47%, respectively). The Kansas City Cardiomyopathy Questionnaire significantly improved in the HF-DMP vs usual care for the Physical Limitation (11.3 ± 2.9 vs 20.8 ± 3.6; P= .039) and Social Limitation subscales (6.0 ± 3.1 vs 17.9 ± 3.8; P= .016). Self-care of HF Index was not significant. The total number of events (composite endpoint) totaled 517 (231 in HF-DMP and 286 in usual care). Differences in the 60-day hospitalization rate [mean HF-DMP rate 0.43 (SE 0.03) vs usual care 0.54 (SE 0.05), P= .04] and mortality rate (HF-DMP 5.2% vs usual care 10.8%, P < .001) were significant. The composite endpoint was high for patients with HF in SNF regardless of group. Rehospitalization and mortality rates were reduced by the HF-DMP. HF-DMPs in SNFs may be beneficial to the outcomes of patients with HF. SNFs should consider structured HF-DMPs for their patients.

Disease Management in Skilled Nursing Facilities Improves Outcomes for Patients With a Primary Diagnosis of Heart Failure.

Skilled nursing facilities (SNFs) are common destinations after hospitalization for patients with heart failure (HF). Our objective was to determine if patients in SNFs with a primary hospital discharge diagnosis of HF benefit from an HF disease management program (HF-DMP). This is a subgroup analysis of multisite, physician and practice blocked, cluster-randomized controlled trial of HF-DMP vs usual care for patients in SNF with an HF diagnosis. The HF-DMP standardized SNF HF care using HF practice guidelines and performance measures and was delivered by an HF nurse advocate. Patients with a primary hospital discharge diagnosis of HF discharged to SNF. Composite outcome of all-cause hospitalization, emergency department visits, and mortality were evaluated at 30 and 60days post SNF admission. Linear mixed models accounted for patient clustering at the physician level. Of 671 individuals enrolled in the main study, 125 had a primary hospital discharge diagnosis of HF (50 HF-DMP; 75 usual care). Mean age was 79 ± 10years, 53% women, and mean ejection fraction 46% ± 15%. At 60days post SNF admission, the rate of the composite outcome was lower in the HF-DMP group (30%) compared with usual care (52%) (P= .02). The rate of the composite outcome at 30days for the HF-DMP group was 18% vs 31% in the usual care group (P= .11). Patients with a primary hospital discharge diagnosis of HF who received HF-DMP while cared for in an SNF had lower rates of the composite outcome at 60days. Standardized HF management during SNF stays may be important for patients with a primary discharge diagnosis of HF.

Abstract 11680: Comorbidity and Cognitive Function Predict Efficiency of a Disease Management Program in Reducing Short-Term Readmission in Heart Failure

Background: Both comorbidity and cognitive impairment are highly prevalent and predictive of outcomes in heart failure (HF). We sought whether these risk factors could identify patients most likely to benefit from a HF disease management program (DMP) to reduce readmission. Methods: 1363 consecutive HF patients were prospectively followed for 1 month after discharge. Of these, 431 (31%) patients received a DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review). Primary outcome was all-cause readmission/death at 30-day post-discharge. Charlson comorbidity index (CCI) was calculated based on discharge diagnoses and categorised as mild (CCI≤2), moderate (CCI 3-4) and severe (CCI≥5). Cognitive function was assessed on discharge using the Montreal Cognitive Assessment (MoCA) and classified as normal (MoCA 26-30), low-normal (MoCA 23-25), mildly impaired (MoCA 17-22) and moderate/severely impaired (MoCA≤16). Results: 28% (386/1363) of patients died or were readmitted within 30 days after discharge. Both CCI (relative risk RR=1.06 [95% CI: 1.03, 1.10] per point) and MoCA (RR=0.95 [95% CI: 0.94, 0.96] per point) were significantly predictive of outcome, with a statistically significant interaction (p=0.032). Cross-classification of CCI and MoCA identified a group of high-risk patients (≥mild cognitive impairment and/or severe Charlson comorbidity index) who had a 2.02-fold higher risk of 30-day readmission/death (34%, 309/903) than patients with mild/moderate CCI and without cognitive impairment (17%, 72/426). The effect size of DMP was significantly stronger (p=0.034) among the high-risk patients (RR=0.62 [95% CI: 0.49, 0.77]) compared to low-risk patients (RR=0.98 [95% CI: 0.61, 1.58]). Conclusion: Comorbidities and cognitive impairment strongly predict short-term adverse outcomes in HF and can be used to identify patients who are most likely to benefit from a DMP.

Cognitive impairment is a determinant of patient response to disease management programs to reduce readmission in heart failure

Abstract Background Cognitive impairment (CI) is highly prevalent in heart failure (HF), and increases patients' risks of readmission. Purpose This study sought to determine whether the presence and degree of CI could identify patients most likely to benefit from a HF disease management program (DMP) to reduce readmissions. Methods 1152 consecutive Australian patients admitted with HF (2014–17) were prospectively followed-up for 12 months. Of these, 324 patients who received DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review) were matched (1:2 ratio) with 648 usual care patients. Cognitive function was assessed either on the day of or one day before discharge using the Montreal Cognitive Assessment (MoCA). Outcomes included readmission or death at 1-, 3- and 12-months, and days-at-home within 12 months, from discharge. Results Poorer cognitive function was associated with all adverse outcomes. Compared with usual care, DMP was associated with lower odds of 30-day (OR=0.60 [0.40, 0.91]) and 90-day (OR=0.53 [0.36, 0.77]) readmission or death, and with 19 more days-at-home within 12 months, independent of HF therapy. The effect sizes of these associations were greater for patients with diminished cognition than those with normal cognition (interaction p=0.036), and might have been more pronounced among those with mild CI compared with those with more severe CI (MoCA score 17–22, OR=0.42 [0.21, 0.87] at 30-day, OR=0.31 [0.16, 0.60] at 90-day). Patients with normal cognition had fewer events, irrespective of DMP. Conclusions Cognitive function may determine how HF patients respond to a DMP. Cognitive screening before implementation of a DMP may allow personalized plans for patients with different levels of cognitive function Funding Acknowledgement Type of funding sources: None.

Cognitive impairment as a determinant of response to management plans after heart failure admission.

Cognitive impairment (CI) is highly prevalent in heart failure (HF), and increases patients' risks of readmission. This study sought to determine whether the presence and degree of CI could identify patients most likely to benefit from a HF disease management programme (DMP) to reduce readmissions. A total of 1152 consecutive Australian patients admitted with HF (2014-2017) were prospectively followed up for 12 months. Of these, 324 patients who received DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review) were matched (1:2 ratio) with 648 usual care patients. Cognitive function was assessed either on the day of or one day before discharge using the Montreal Cognitive Assessment (MoCA). Outcomes included readmission or death at 1, 3 and 12 months, and days at home within 12 months of discharge. Poorer cognitive function was associated with all adverse outcomes. Compared with usual care, DMP was associated with lower odds of 30-day [odds ratio (OR) 0.60, 95% confidence interval 0.40, 0.91] and 90-day (OR 0.53, 95% confidence interval 0.36, 0.77) readmission or death, and with 19 more days at home within 12 months, independent of HF therapy. The effect sizes of these associations were greater for patients with diminished cognition than those with normal cognition (interaction P=0.036), and might have been more pronounced among those with mild CI compared with those with more severe CI (MoCA score 17-22; OR 0.42, 95% confidence interval 0.21, 0.87) at 30 days (OR 0.31, 95% confidence interval 0.16, 0.60 at 90 days). Patients with normal cognition had fewer events, irrespective of DMP. Cognitive function may determine how HF patients respond to a DMP. Cognitive screening before implementation of a DMP may allow personalized plans for patients with different levels of cognitive function.

Cognitive function assessment for personalized heart failure disease management programmes

Cognitive function assessment for personalized heart failure disease management programmes

Impact of primary care involvement and setting on multidisciplinary heart failure management: a systematic review and meta-analysis.

Multidisciplinary disease management programmes (DMPs) are a cornerstone of modern guideline‐recommended care for heart failure (HF). Few programmes are community initiated or involve primary care professionals, despite the importance of home‐based care for HF. We compared the outcomes of different multidisciplinary HF DMPs in relation to their recruitment setting and involvement of primary care health professionals. We conducted a systematic review and meta‐analysis of randomized controlled trials published in MEDLINE, Embase, and Cochrane between 2000 and 2020 using Cochrane Collaboration methodology. Our meta‐analysis included 19 randomized controlled trials (7577 patients), classified according to recruitment setting and involvement of primary care professionals. Thirteen studies recruited in the hospital (n = 5243 patients) and six in the community (n = 2334 patients). Only six studies involved primary care professionals (n = 3427 patients), with two of these recruited in the community (n = 225 patients). Multidisciplinary HF DMPs that recruited in the community had no significant effect on all‐cause and HF readmissions nor on mortality, irrespective of primary care involvement. Studies that recruited in the hospital demonstrated a significant reduction in mortality (relative risk 0.87, 95% confidence interval [CI] [0.76, 0.98]), HF readmissions (0.70, 95% CI [0.54, 0.89]), and all‐cause readmissions (0.72, 95% CI [0.60, 0.87]). However, the difference in effect size between recruitment setting and involvement of primary care was not significant in a meta‐regression analysis. Multidisciplinary HF DMPs that recruit in the community have no significant effect on mortality or hospital readmissions, unlike DMPs that recruit in the hospital, although the difference in effect size was not significant in a meta‐regression analysis. Only six multidisciplinary studies involved primary care professionals. Given demographic evolutions and the importance of integrated home‐based care for patients with HF, future multidisciplinary HF DMPs should consider integrating primary care professionals and evaluating the effectiveness of this model.

Reducing Readmission in Heart Failure: The Role of Patients’ Cognitive Function

This study sought to determine whether the presence and degree of cognitive impairment (CI) could identify patients most likely to benefit from a heart failure (HF) disease management program (DMP) to reduce readmissions.

Implementation of a Disease Management Program in Adult Patients With Heart Failure.

Approximately 5.7 million people in the United States are diagnosed and living with heart failure (HF), with projected prevalence rates to increase 46% by 2030. Heart failure leads hospital admissions in the United States for individuals 65 years or older, with many acute exacerbation admissions resulting from a lack of medication management, poor patient treatment plan adherence, and lack of appropriate follow-up within the health care system. In 2017, the 30-day HF readmission rate at the facility of implementation was 27%, 3% higher than the national average and, more specifically, 18.5% for the cardiac care unit (CCU). The aim of this study was to develop an HF disease management program to reduce 30-day readmission rates for HF patients through the implementation of a structured program including self-care education utilizing the teach-back method, multimodal medication reconciliation, multidisciplinary consultation, telephone follow-up within 48-72 hr of discharge, and follow-up visit within 7-10 days of discharge. The implementation of the disease management program took place at a major military treatment facility in the continental United States. The facility is a teaching facility housing a 272-bed multispecialty hospital and an ambulatory complex. The implementation took place on the CCU, the primary unit for cardiac admissions, with approximately 30 admissions a month for a primary diagnosis of HF. In August 2018, a multidisciplinary disease management program was implemented to include patient education utilizing the teach-back method, multimodal medication reconciliation, multidisciplinary consultation, telephone follow-up within 48-72 hr of discharge, and follow-up visit within 7-10 days of discharge. Data were collected and analyzed for 90 days and compared with retrospective data from 2017. Participants in the disease management program had a statistically significant improvement (p < .001) in the hospital readmission rate. The overall 30-day readmission rate decreased from 27% to 10.2% during the implementation period, a decrease of 38%. Ninety-three percent of the patients completed the self-care education, and telephone follow-up was successfully achieved with 96% of these patients. Only 4 patients in the HF disease management program experienced readmission within 30 days. Patients and caregivers reported increased satisfaction with their care due to the disease management program and increased follow-up with care. The findings of this innovation suggest that a multidisciplinary disease management program can reduce avoidable 30-day readmissions. The program improved patient follow-up and decreased follow-up appointment no-shows. Multiple participants expressed increased patient satisfaction. The program supports the need for coordinated, interdisciplinary disease management to improve the quality of life of those affected by HF and improve the use of resources to reduce the overall health care burden. Case management is critical to the organized care of HF patients due to the complex, individualized care to achieve optimum patient outcomes.

Prescribing and Deprescribing for Heart Failure

Prescribing and Deprescribing for Heart Failure

Rationale and design of a risk-guided strategy for reducing readmissions for acute decompensated heart failure: the Risk-HF study.

AimsHeart failure (HF) readmission commonly arises owing to insufficient patient knowledge and failure of recognition of the early stages of recurrent fluid congestion. In previous work, we developed a score to predict short‐term hospital readmission and showed that higher‐risk patients benefit most from a disease management programme (DMP) that included enhancing knowledge and education by a nurse. We aim to evaluate the effectiveness of a novel, nurse‐led HF DMP in selected patients at high risk of short‐term hospital readmission, using ultrasound‐guided diuretic management and artificial intelligence to enhance HF knowledge in an outpatient setting.Methods and resultsRisk‐HF is a prospective multisite randomized controlled trial that will allocate 404 patients hospitalized with acute decompensated HF, and ≥33% risk of readmission and/or death at 30 days, into risk‐guided nurse intervention (DMP‐Plus group) compared with usual care. Intervention elements include (i) fluid management with a handheld ultrasound (HHU) device at point of care; (ii) post‐discharge follow‐up; (iii) optimal programmed drug titration; (iv) better transition of care; (v) intensive self‐care education via an avatar‐based ‘digital health coach’; and (vi) exercise guidance through the digital coach. Usual care involves standard post‐discharge hospital care. The primary outcome is reduced death and/or hospital readmissions at 30 days post‐discharge, and secondary outcomes include quality of life, fluid management efficacy, and feasibility and patient engagement. Assuming that our intervention will reduce readmissions and/or deaths by 50%, with a 1:1 ratio of intervention vs. usual care, we plan to randomize 404 patients to show a difference at a statistical power of 80%, using a two‐sided alpha of 0.05. We anticipate this recruitment will be achieved by screening 2020 hospitalized HF patients for eligibility. An 8 week pilot programme of our digital health coach in 21 HF patients, age > 75 years, showed overall improvements in quality of life (13 of 21), self‐care (12 of 21), and HF knowledge (13 of 21). A pilot of the use of HHU by nurses showed that it was feasible and accurate.ConclusionsThe Risk‐HF trial will evaluate the effectiveness of a risk‐guided intervention to improve HF outcomes and will evaluate the efficacy of trained HF nurses delivering a fluid management protocol that is guided by lung ultrasound with an HHU at point of care.