Postdischarge Quality Of Life Research Articles

Pediatric Delirium Educational Tool Development With Intensive Care Unit Clinicians and Caregivers in Canada: Focus Group Study.

Pediatric intensive care unit (PICU)-associated delirium contributes to a decline in postdischarge quality of life, with worse outcomes for individuals with delayed identification. As delirium screening rates remain low within PICUs, caregivers may be able to assist with early detection, for which they need more education, as awareness of pediatric delirium among caregivers remains limited. This study aimed to develop an educational tool for caregivers to identify potential delirium symptoms during their child's PICU stay, educate them on how to best support their child if they experience delirium, and guide them to relevant family resources. Web-based focus groups were conducted at a tertiary pediatric hospital with expected end users of the tool (ie, PICU health care professionals and caregivers of children with an expected PICU length of stay of over 48 h) to identify potential educational information for inclusion in a family resource guide and to identify strategies for effective implementation. Data were analyzed thematically to generate requirements to inform prototype development. Participants then provided critical feedback on the initial prototype, which guided the final design. In all, 24 participants (18 health care professionals and 6 caregivers) attended 7 focus groups. Participants identified five informational sections for inclusion: (1) delirium definition, (2) key features of delirium (signs and symptoms), (3) postdischarge outcomes associated with delirium, (4) tips to inform family-centered care, and (5) education or supportive resources. Participants identified seven design requirements: information should (1) be presented in an order that resembles the structure of the clinical discussion around delirium; (2) increase accessibility, recall, and preparedness by providing multiple formats; (3) aim to reduce stress by implementing positive framing; (4) minimize cognitive load to ensure adequate information processing; (5) provide supplemental electronic resources via QR codes; (6) emphasize collaboration between caregivers and the health care team; and (7) use prompting questions to act as a call to action for caregivers. Key design requirements derived from end-user feedback were established and guided the development of a novel pediatric delirium education tool. Implementing this tool into regular practice has the potential to reduce distress and assist in the early recognition and treatment of delirium in the PICU domain. Future evaluation of its clinical utility is necessary.

Impact of a specialized oral nutritional supplement on quality of life in older adults following hospitalization: Post-hoc analysis of the NOURISH trial

Both during and after hospitalization, nutritional care with daily intake of oral nutritional supplements (ONS) improves health outcomes and decreases risk of mortality in malnourished older adults. In a post-hoc analysis of data from hospitalized older adults with malnutrition risk, we sought to determine whether consuming a specialized ONS (S-ONS) containing high protein and beta-hydroxy-beta-methylbutyrate (HMB) can also improve Quality of Life (QoL). We analyzed data from the NOURISH trial-a randomized, placebo-controlled, multi-center, double-blind study conducted in patients with congestive heart failure, acute myocardial infarction, pneumonia, or chronic obstructive pulmonary disease. Patients received standard care+S-ONS or placebo beverage (target 2 servings/day) during hospitalization and for 90 days post-discharge. SF-36 and EQ-5D QoL outcomes were assessed at 0-, 30-, 60-, and 90-days post-discharge. To account for the missing QoL observations (27.7%) due to patient dropout, we used multiple imputation. Data represent differences between least squares mean (LSM) values with 95% Confidence Intervals for groups receiving S-ONS or placebo treatments. The study population consisted of 622 patients of mean age ±standard deviation: 77.9±8.4 years and of whom 52.1% were females. Patients consuming placebo had lower (worse) QoL domain scores than did those consuming S-ONS. Specifically for the SF-36 health domain scores, group differences (placebo vs S-ONS) in LSM were significant for the mental component summary at day 90 (-4.23 [-7.75,-0.71]; p=0.019), the domains of mental health at days 60 (-3.76 [-7.40,-0.12]; p=0.043) and 90 (-4.88 [-8.41,-1.34]; p=0.007), vitality at day 90 (-3.33 [-6.65,-0.01]; p=0.049) and social functioning at day 90 (-4.02 [-7.48,-0.55]; p=0.023). Compared to placebo, differences in LSM values for the SF-36 general health domain were significant with improvement in the S-ONS group at hospital discharge and beyond: day 0 (-2.72 [-5.33,-0.11]; p=0.041), day 30 (-3.08 [-6.09,-0.08]; p=0.044), day 60 (-3.95 [-7.13,-0.76]; p=0.015), and day 90 (-4.56 [-7.74,-1.38]; p=0.005). In hospitalized older adults with cardiopulmonary diseases and evidence of poor nutritional status, daily intake of S-ONS compared to placebo improved post-discharge QoL scores for mental health/cognition, vitality, social functioning, and general health. These QoL benefits complement survival benefits found in the original NOURISH trial analysis. NCT01626742.

Effect of Different Factors on the Quality of Life and Sequelae of COVID-19 Patients After Discharge

Abstract Background The continued spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains an international public health emergency, resulting in a significant global disease burden. The long-term effects of SARS-CoV-2 infection in humans and the long-term prognosis of patients with coronavirus disease 2019 (COVID-19) after discharge remain unclear. We aimed to assess the quality of life (QoL) and sequelae in patients with COVID-19 after discharge from the hospital by conducting multiple follow-up visits to understand the long-term effects of SARS-CoV-2 on patients' health and its possible influencing factors. Methods COVID-19 patients discharged from Huoshenshan Hospital (Wuhan, China) between February 15 and April 5, 2020, were followed up at 6, 9, and 12 months after discharge. They completed questionnaires on postdischarge QoL and sequelae under the guidance of medical staff with professional training. The demographic and clinical characteristics of the COVID-19 patients were analyzed using descriptive statistics. A generalized estimating equation model was used to analyze the QoL-related factors. The χ 2 test (or Fisher exact test) and multivariate logistic regression analysis were used to analyze the sequelae and influencing factors. Results A total of 175 patients participated in at least 1 follow-up visit, and 120 completed all 3 follow-up visits. Patients diagnosed with severe and critically ill COVID-19 had worse mental conditions (χ 2 = 7.653, P = 0.022) than those with the nonsevere type (not severe or critical) and were more likely to feel fatigued (χ 2 = 4.836, P = 0.028). Female patients had a higher risk of sleep disturbance (χ 2 = 10.026, P = 0.002) and dyspnea (χ 2 = 5.672, P = 0.017) and had more difficulty returning to their original work and life (χ 2 = 8.922, P = 0.003) than male patients. Patients with diabetes had a worse appetite (χ 2 = 4.669, P = 0.031) and were more prone to sleep disturbance (χ 2 = 4.417, P = 0.036) after discharge. The proportion of patients with at least 1 sequela increased from 29.76% (50/168) at 6 months to 51.11% (69/135) at 9 months (χ 2 = 14.305, P < 0.001). Compared with the nonsevere type, patients diagnosed with severe and critically ill COVID-19 had an odds ratio (OR) of 4.325 (95% confidence interval [CI], 1.215–15.401) for memory decline. Female patients had an OR of 4.632 (95% CI, 1.716–12.501) for joint or muscle pain. Patients with hypertension had an OR of 3.014 (95% CI, 1.193–7.615) for joint or muscle pain. Conclusion One year after discharge, there were still some patients with varying degrees of decline in QoL and sequelae, which occurred in all follow-up visits. Moreover, QoL and sequelae after discharge were related to sex, clinical classification of COVID-19, and underlying diseases.

Improving Mobility in Critically Ill Patients in a Tertiary Care ICU: Opportunities and Challenges

BackgroundPatients in the intensive care unit (ICU) are subjected to prolonged bed rest secondary to critical illness and related therapies. Data suggest that such bed rest can have adverse consequences on the post-discharge quality of life. There is limited data from India on mobilization practices. We undertook a quality improvement (QI) initiative to understand our mobilization practices, identify challenges, and test interventions.Materials and methodsWe carried out a three-phase QI project, and the study was conducted in our 24-bedded ICU. Pre-intervention and post-intervention mobilization performance and scores were analyzed. We also recorded data on adverse events and barriers to mobilization. Descriptive statistics were used to report all the results.ResultsA total of 140 patients (1,033 patient days) and 207 patients (932 patient days) were included in our initial audit and post-implementation audit, respectively. In pre-implementation, 31.3% of patients were mobilized with an average mobility score of 2 and this improved to 57.9% with average mobility score of 3.4. Additionally, we demonstrated improvements in the mobility scores of our intubated patients (49.8% achieving a mobility score of 3–5 as compared to 16.7%).ConclusionA multidisciplinary approach is feasible and resulted in significant improvements in early mobilization among critically ill adults.How to cite this articleMohan S, Patodia S, Kumaravel S, Venkataraman R, Vijayaraghavan BKT. Improving Mobility in Critically Ill Patients in a Tertiary Care ICU: Opportunities and Challenges. Indian J Crit Care Med 2021;25(1):34–42.

Post-Discharge Quality of Life in Patients Receiving a Long-Term Ventricular Assist Device: Focus on Anxiety, Depression and Post Traumatic Stress Disorder

Reported outcomes after left ventricular assist device (LVAD) implant include mortality, hospital readmission and severe adverse events. We have less information about patients' perceptions of their quality of life (QOL) after hospital discharge. We conducted a prospective two-center international pilot study to assess anxiety, depression and post-traumatic stress disorder (PTSD) following LVAD implant as bridge to transplant (BTT) or destination therapy (DT). 124 patients ≥ 30 days after discharge post-implant were assessed telephonically or during on-site clinic visits. GAD-7 is a 7 item scale assessing anxiety; PHQ-9 is a 9 item scale assessing depression; and IES-R is a 22 item scale reflecting self-described symptoms of PTSD. EQ-VAS is a 1 item response reflecting health self-assessment from 0-100 (worst to best imaginable). Mean patient age was 57.5±15.2 yrs; 15% female; 47% >1 yr post-implantation; 56% DT; 67% had HeartMate 3. High scores for anxiety and depression (some with suicidal ideation) warranted further evaluation in 18% and 8% of patients respectively. Risk of severe anxiety was higher in patients < 60 yrs (p <0.01). 23% of patients had scores consistent with PTSD, and in 80% of these it was moderate to very severe. The risk of anxiety, depression and PTSD was highest in the patients with EQ-VAS <50 (p <0.05) (Figure). No differences related to gender or LVAD strategy. Although the majority of LVAD out-patients reported low levels of anxiety, depression and did not exhibit symptoms of PTSD, an important minority had symptoms severe enough to warrant evaluation for therapeutic intervention. A low EQ-VAS may be helpful in identifying patients at risk but does not specify its nature or severity. Standardized, regular assessments with GAD-7, PHQ-9 and IES-R may help to identify patients in urgent need of evaluation for severe anxiety, depression (including suicidal ideation) and PTSD.

Post-Discharge Quality of Life with a Long-Term Ventricular Assist Device: Focus on Functional Disability and Impact of Health Status

Reported outcomes after left ventricular assist device (LVAD) implantation include mortality, hospital readmission and severe adverse events. We have less information about patients' perceptions of their quality of life (QOL) after hospital discharge. We conducted a prospective two-center international pilot study to assess at-home functional capacity and QOL following LVAD implantation as a bridge to transplant (BTT) or destination therapy (DT). 124 patients ≥ 30 days after discharge post-implantation were assessed telephonically or during on-site clinic visits. WHODAS 2.0 assesses disability in cognition, mobility, self-care, interpersonal relationships, work/household roles and societal participation. EQ-5D assesses impact of health status on 5 life dimensions. EQ-VAS reflects health self-assessment from 0-100 (worst to best imaginable). Mean patient age was 57.5±15.2 yrs; 15% female; 47% >1 yr post-implantation; 56% DT; 67% had HeartMate 3. Disability was minimal in 67% but moderate to severe in 33% (Figure). In the EQ-5D, moderate to extreme problems were reported with usual activities (33%), pain (32%), mobility (31%), self-care (24%) and anxiety (22%). At assessment, 42% reported an EQ-VAS ≥70, but 25% reported <50. 96% of patients in the best quintile of EQ-VAS reported no or mild disability (p < 0.01), but so did 30% of patients in the worst quintile. The majority of LVAD out-patients reported good functional capacity, little impact of their health on major life domains, and high subjective health self-assessment. Yet a substantial minority did not enjoy a high QOL. A good EQ-VAS correlates with high functional ability, but some patients have a poor EQ-VAS even without disability. Routine assessment of functional ability and health status is feasible in post-discharge LVAD patients. Standardized, regular assessments could help us identify factors associated with a high versus low QOL.

INSUFFICIENT CALORIC INTAKE IS ASSOCIATED WITH POOR QUALITY OF LIFE AND READMISSION BURDEN POST-DISCHARGE IN OLDER PATIENTS WITH HEART FAILURE

Few studies have described dietary deficiencies in older patients hospitalized for heart failure (HF). We hypothesized that insufficient caloric intake (iCI) would predict poorer post-discharge quality of life (QOL) and greater readmission burden in HF. The GOURMET-HF study randomized HF inpatients

Practice patterns in the management of congestive heart failure and post-discharge quality of life: A hospital-based cross-sectional study.

Objective:The objective of the study is to identify the etiology, risk factors, frequency of major and minor components of the Framingham criteria for heart failure, discharge medications, mortality, and quality of life after discharge from the hospital, for patients who were admitted to the in-patient unit of a tertiary care hospital in central India, with a diagnosis of congestive heart failure (CHF).Methods:This hospital-based cross-sectional study involved retrospective chart review of patients who were admitted to the in-patient unit with a diagnosis of CHF. These patients were then attempted to reach via their telephone numbers listed in the medical records and their current quality of life was assessed using Euro-QoL 5D questionnaire.Results:In the 69 patients who were admitted to the hospital with congestive cardiac failure during the pre-defined period, ischemic heart disease was the most common etiology and smoking was the most common risk factor for the development of CHF. The most common findings based on Framingham criteria were dyspnea on mild exertion, rales and bilateral ankle edema. It was determined that one-fourth of the individuals were non-compliant to the medical treatment and more than half of the patients had a poor health score.Conclusion:Smoking remains to be a major risk factor for patients to develop ischemic heart disease and subsequent CHF. Patients with congestive cardiac failure also had severe deterioration in their quality of life after discharge from the hospital, implying the need for improving efforts toward prevention and better management.

Quality of life and its associated factors among patients with COPD before and after an exacerbation in Sri Lanka

Abstract Purpose: This study was done to describe quality of life (QOL) and its associated factors among patients with Chronic Obstructive Pulmonary Disease (COPD) before and after an exacerbation in the premier province of Sri Lanka, which is a lower middle income country. Methods: Longitudinal study with two waves of data collection was done in 13 government hospitals among 289 participants in 2015. Sample size was calculated using a formula for estimating QOL in numerical scale with reference to documented global literature. The study population included admitted patients with an exacerbation of COPD. The pre-exacerbation and the post-discharge one month quality of life were assessed using SF-36 generic QOL tool. Bivariate analysis was followed by multivariate analysis. Results: For seven QOL domains there was a significant decline in QOL at one month post-discharge (p<0.05) compared to pre-exacerbation figures. Age (two domains) income (seven domains) and health infrastructure (seven domains) significantly associated with the pre-exacerbation QOL. Pre-exacerbation QOL significantly correlated with post-discharge QOL for five domains. A higher-age, higher monthly income, better health-infrastructure and a lower severity of the exacerbation were independent predictors of a lowered QOL following an exacerbation. Conclusions: Younger age, higher income and better health-infrastructure are associated with higher baseline QOL of COPD patients. The baseline QOL scores are worsened following an exacerbation. Post-discharge QOL can be predicted with pre-exacerbation QOL for five domains of QOL. Older age, higher income level, better level of health infrastructure and lower severity of the exacerbation are associated with a reduction of the pre-exacerbation QOL at 1one month from the hospital discharge. Key Words: COPD, Quality of life, Exacerbation, Sri Lanka, SF-36, Chronic Respiratory Disease, Chronic Obstructive Pulmonary Disease

Factors influencing pre-stroke and post-stroke quality of life among stroke survivors in a lower middle-income country.

Quality of life (QOL) reflects the individual's perception of the position within living contexts. This study was done to describe pre- and post-stroke QOLs of stroke survivors. A prospective longitudinal study was done among stroke survivors admitted to 13 hospitals in the western province of Sri Lanka. The calculated sample size was 260. The pre-stroke and post-discharge one-month QOL was gathered using short form-36 (SF-36) QOL tool. SF-36 includes questions on eight domains: general health, physical functioning, pain, role limitation due to physical problems, social functioning, vitality, role limitations due to emotional problems, and mental health. Univariate analysis was followed by determining the independent risk factors through multivariate analysis. The response rate was 81%. The disability was measured by the modified Rankin scale which ranges from 0 (no symptoms) to 6 (fatal outcome). The median (IQR) disability score was 4 (3 to 5). The post-discharge QOL scores were significantly lower than pre-stroke values (p<0.05). With a higher pre-stroke QOL, younger age was significantly associated in six domains and higher income and better health infrastructure in two domains (p<0.05). Six factors were determined to be independent risk factors for lower post-discharge QOL scores of SF-36: younger age (for general health and role limitation-physical domains), female gender (for physical functioning and pain domains), lower health infrastructure (for general health, vitality, and mental health domains), lower education (for pain domain), higher disability (for general health, physical functioning, vitality, social functioning, and mental health domains), and hypercholesterolemia (for role limitation-emotional domain). Stroke survivors have not regained their pre-stroke QOL at 1month following the hospital discharge irrespective of income level and pre-stroke QOL. Higher pre- and post-stroke QOLs are associated with better statuses of social determinants of health.

The Development of Enhanced Recovery After Surgery Across Surgical Specialties.

Enhanced recovery after surgery (ERAS®) principles have gained traction in variety of surgical disciplines. The promise of a reduced length of stay without compromising patient safety or increasing readmission rates has produced a body of literature examining the implementation of ERAS in the care of general, thoracic, urologic, and gynecologic surgery patients. We performed a review of the literature pertaining to studies of ERAS implementation across colorectal surgery, general surgery, thoracic surgery, urology, and gynecology. The extent of ERAS implementation and reported outcomes across key studies as well as systematic reviews and meta-analyses in each field were summarized. The implementation of ERAS protocols has not been uniform across surgical specialties. Despite this, ERAS has produced improvements in patient outcomes. The most commonly described benefit of ERAS application has been reduced length of stay; complication and readmission rates are most consistently decreased in the colorectal literature. Studies have started to measure more nuanced measures of postoperative patient well-being. Efforts are growing to standardize ERAS protocols across diverse fields and call attention to the need for quality control. Challenges remain in the study and execution of ERAS. Controlling for adherence to ERAS components and implementing uniform ERAS protocols across studies are burgeoning topics that have significant implications for study design. The practice of ERAS and its benefits to patients are expected to evolve. Assessing improvements in postdischarge quality of life, timing of return to work and independent living, and adherence to scheduled delivery of adjuvant treatments will strengthen future ERAS investigations.

Pre-event quality of life and its influence on the post-event quality of life among patients with ST elevation and non-ST elevation myocardial infarctions of a premier province of Sri Lanka

BackgroundPre-event Quality of Life (QOL) reflects the true social circumstances in which people live prior to the onset of myocardial infarctions. It is believed to be a predictor of the post-event QOL. The aim of this study was to describe the pre-event QOL and its influence on the post-event Quality of Life among patients with ST elevation (STEMI) and Non-ST elevation myocardial infarctions (NSTEMI) using Short Form-36 (SF-36), a generic QOL tool with 8 domains. Documented literature is rare in this regard in Sri Lanka, which is a lower-middle-income country.MethodsA cross-sectional study with a 28-day post-discharge follow-up was carried out in 13 hospitals. Three hundred and forty-four patients who were diagnosed with STEMI or NSTEMI were recruited during the hospital stay. The pre-event QOL was measured using an interviewer-administered questionnaire which included the SF-36 QOL tool and medical details. Follow-up QOL was gathered using a questionnaire that was filled and posted back by participants. Of the recruited sample, 235 responded for the follow-up component. Analysis was conducted for associations between pre- and post-discharge QOL. Furthermore, comparisons were made between the STEMI and NSTEMI groups. Mann Whiney U test, Wilcoxon signed rank test and chi square test were used in the analysis.ResultsThe post-event QOL was lower in seven out of eight domains than the pre-event QOL (p < 0.05). The NSTEMI group had more risk factors and a significantly lower pre-event QOL for seven domains (p < 0.05), when compared to the STEMI group. For seven domains, the post-discharge QOL was not significantly different (p > 0.05) between the STEMI and NSTEMI groups. Post-discharge general-health QOL domain score was higher than the pre-MI score (p = 0.028) and was higher in the STEMI group compared to the NSTEMI group (p = 0.042). Regression analysis showed a significant beta coefficient between pre- and post-QOL for five domains in STEMI and for all domains in NSTEMI groups when adjusted for the disease severity. The R square values ranged from 12.3 to 62.3% for STEMI and 7.3 to 64.8% for NSTEMI.ConclusionsPre-event QOL is lower in the NSTEMI group compared to the STEMI group. Patients do not regain the previous QOL within one month post-discharge. Post-discharge QOL can be predicted by the pre-event QOL for most domains.

Abstract TP378: Long Term Follow Up Telephone Evaluation of Post Stroke Quality of Life is Feasible and Effective

Background: The long-term follow-up of clinical outcomes in patients admitted with acute stroke can identify relevant clinical data in the prevention of stroke recurrence as well as measure the quality of life of such patients. Follow-up after discharge in hospitals without stroke clinics can be a challenge. Therefore we created in our hospital an outcomes measurement nuclei characterized as a data collection center, with the main objective of periodically measuring clinical outcomes and quality of life of patients after hospital discharge.This sector works together with the different clinical specialties in providing information with a focus on outcome indicators, using questionnaires to estimate the parameters of evaluation of health states.Our objective was to describe data obtained from this data collection center evaluating post-discharge quality of life of patients treated in our stroke center 30, 90, 180 days and 01 years after the diagnosis. Methods: The study was conducted from January 2012 to March 2016, at a tertiary, general, private hospital in São Paulo, Brazil. Phone calls using the EuroQol instrument (EQ-5D) to measure quality of life were performed. The modified Rankin scale and a structured questionnaire to identify stroke recurrence, readmissions and medication failures were also applied. Results: We conducted 2184 telephone calls and obtained 1727 (79%) successful contacts. The mean EQ-5D at 30 days was: 0.732 +/-0.558; at 90 days: 0.722 +/- 0.358; at 180 Days: 0.781 +/- 0.326; and at 12 months 0.766 +/-0.349. During the follow-up, 31 patients (2%) died. The main reasons for censuring patients were unsuccessful contact after 3 attempts (51%); outdated registration data (3%) and refusals (9%). Conclusion: In conclusion, monitoring of standardized clinical outcomes after stroke is possible even in private non academic hospitals, allowing the acquisition of quality of care indicators and patient centered outcomes.

Predictors of 6-month health utility outcomes in survivors of acute respiratory distress syndrome

BackgroundWith improving short-term mortality in acute respiratory distress syndrome (ARDS), understanding and improving quality of life (QOL) outcomes in ARDS survivors is a clinical and research priority. We sought to...

Longitudinal change in quality of life following hospitalisation for acute exacerbations of COPD

BackgroundCurrent guidelines for management of patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (COPD) recommend that clinical decisions, including escalation to assisted ventilation, be informed by an estimate...

Post-discharge insomnia symptoms are associated with quality of life impairment among survivors of acute lung injury

Sleep disturbance is common during critical illness, yet little is known about its prevalence or role in post-discharge quality of life among high-risk acute lung injury (ALI) patients. In a prospective cohort of 61 mechanically ventilated ALI patients, we examined the association between insomnia symptoms and quality of life six months after discharge. Subjects completed surveys rating quality of life (MOS SF-36), post-traumatic stress disorder (PCL), and depression (PHQ-9). Using an individual item from the PCL, we defined insomnia symptoms as moderate or greater trouble falling or staying asleep in the past month. We performed multivariable linear regression to examine the association between insomnia symptoms and SF-36 physical and mental component summary scores, adjusting for PTSD and depression. Forty subjects (85% of eligible) completed six-month questionnaires; 20 (50%) met criteria for insomnia symptoms. After adjustment for PTSD and depression, insomnia symptoms remained significantly associated with worse physical component summary scores (adjusted mean difference=-8.8; 95% CI: -15.0, -2.5; P<0.01). Post-discharge insomnia symptoms were common and significantly associated with physical quality of life impairment among six-month ALI survivors, even after adjustment for PTSD and depression symptoms. Further studies are needed to validate these results and to characterize sleep disturbance after ALI using sleep-specific metrics.

20. Heart failure… at home – sweet home

To foster an environment of guidance and support that would accompany our heart failure population,the staff on our cardiac step down unit wanted to ensure that patients receive the best instructions to prepare for an optimal post discharge quality of life. This process was based on the belief that by providing a “lifeline” of support and user-friendly information, the heart failure patient could function at his or her most effective level at home and lessen time spent enduring inpatient treatment.