Still Searching for the Right Intervention to Improve Transitions of Care for Patients With Heart Failure

In this issue of JAMA Internal Medicine, Masterson Creber et al present the results of the Mighty-Heart randomized clinical trial, which compares 2 transitional care interventions delivered to patients discharged home after a heart failure hospitalization. Participants were randomized to receive a care coordination telephone call from a health system nurse within 48 to 72 hours after discharge or the same telephone call plus a mobile integrated health program that consisted of ongoing nurse care coordination and the availability of community paramedic home visits and telehealth visits with emergency medicine physicians (arranged by the nurse). Among 2003 participants recruited from 11 hospitals in New York, New York, there were no differences between the study groups in the coprimary outcomes of the Kansas City Cardiomyopathy Questionnaire overall summary score or 30-day all-cause hospital readmission, with one-fifth of participants in both groups readmitted within 30 days.