Family Participation in Discharge Is Protective in Heart Failure

Katherine Krive, DO

January 19, 2022

The study covered in this summary was published at as a preprint and has not yet been peer-reviewed.

Key Takeaways

  • A retrospective chart review linked family member participation in the education process at hospital discharge to longer times until patients' next heart failure (HF)-related event.

  • HF-related events, the composite primary outcome of the study, included HF-related deaths, repeat hospitalizations, and emergency department visits for exacerbation of HF.

  • Other discharge parameters studied, which were number of days until outpatient follow-up visit and number of content areas covered during discharge education, were not related to event-free survival.

Why This Matters

  • Because of costly frequent readmissions, HF is a burden on healthcare resources. Support in transition of care from inpatient to outpatient status can help to prevent rehospitalization.

  • The American Heart Association recommends implementing transitional care standards, and the Centers for Medicare and Medicaid Services has used several programs meant to decrease readmissions by improving transitional care at discharge.

  • Discharge education is an important quality measure for transitional care.

  • Social support in HF treatment has previously been identified as a factor in patient wellness and disease management.

  • This study reinforces the importance of including caregivers in discharge education.

Study Design

  • The authors reviewed the charts of patients who were admitted with HF to Chungnam National University Hospital in Korea between 2014 and 2017.

  • A group of 201 patients (mean age, 70.8 years; 50.7% female) met inclusion criteria: The primary reason for index hospitalization was HF, and they were alive at discharge.

  • Records were reviewed for a median of 699 days after discharge, and the length of time until HF events (the primary outcome) within that time period was noted.

  • Cox regression analysis was used to evaluate the effect of the discharge process factors on HF event-free survival.

Key Results

  • Patients were educated with their family members present at 69.7% of discharges.

  • Patients educated without family members present during discharge education were 2.1 times more likely to have a shorter HF event-free survival.

  • Neither length to follow-up visit nor education topics had an effect on event-free survival.

  • Follow-up visits were scheduled an average of 8 days after discharge.

  • Education topics during discharge were variable and included medications (94%), symptom management (41.8%), exercise (15.4%), dietary sodium (12.9%), and pathophysiology (1.5%).


  • The nature of the education provided at discharge for HF-related hospitalization in this study was widely variable, and the lack of effect for the number of educational contents on HF-related events could be due to poor quality of education. Guidelines for discharge education may help to standardize the content.

  • Retrospective record review, in this case dependent on individual clinician documentation, can be omissive of details.

  • The single setting of an academic medical center could limit generalizability.


  • The National Research Foundation of Korea (NRF) and the BK21 FOUR project (Ministry of Education and NRF) provided funding for this project.

  • The authors declare no conflicts of interest.

This is a summary of a preprint research study, "Association Between the Discharge Process and Post-Discharge Events In Patients With Heart Failure," by Kyoung Suk Lee and colleagues from Seoul National University, Gachon University, and Chungnam National University Hospital on provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on

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