Improving care coordination to reduce hospital readmissions for heart failure patients

A Novel Strategy for Addressing Social Barriers to a Successful, Sustained Discharge From the Hospital for Acute Heart Failure

NA · Saint Luke's Health System · NCT05388097

This study is testing a program that helps heart failure patients get the support and resources they need after leaving the hospital to see if it can keep them from going back.

Quick facts

PhaseNA
Study typeInterventional
Enrollment320 (estimated)
Ages18 Years to 99 Years
SexAll
SponsorSaint Luke's Health System (other)
Locations3 sites (Olathe, Kansas and 2 other locations)
Trial IDNCT05388097 on ClinicalTrials.gov

What this trial studies

This initiative aims to enhance post-acute care for patients recovering from heart failure by addressing their social determinants of health. It focuses on providing necessary social services to patients upon discharge from the hospital to prevent rehospitalization. The program involves managed services that coordinate care and support for these patients, ensuring they have access to resources that can aid in their recovery.

Who should consider this trial

Good fit: Ideal candidates for this initiative are adults aged 18 to 99 who are currently hospitalized for acute heart failure and reside in Missouri or Kansas.

Not a fit: Patients under 18 or over 99 years of age will not benefit from this initiative.

Why it matters

Potential benefit: If successful, this initiative could significantly reduce rehospitalization rates for heart failure patients, improving their overall health outcomes.

How similar studies have performed: Other studies addressing social determinants of health have shown promise in reducing readmission rates, suggesting that this approach may be effective.

Eligibility criteria

Show full inclusion / exclusion criteria
Inclusion Criteria:

* Aged 18-99 years
* Resident of Missouri or Kansas
* Current inpatient admission for acute heart failure

Exclusion Criteria:

* Under 18 years or over 99 years of age

Where this trial is running

Olathe, Kansas and 2 other locations

Study contacts

How to participate

  1. Review the eligibility criteria above with your treating physician.
  2. Visit the official trial page on ClinicalTrials.gov for the most current contact information and recruitment status.
  3. Contact the listed study coordinator or principal investigator to request pre-screening. Pre-screening is free and never obligates you to enroll.

View on ClinicalTrials.gov →

Conditions: Heart Failure, heart failure

Last reviewed 2026-05-15 by the Find a Trial editorial team. Information on this page is for educational purposes and is not medical advice. Always consult qualified healthcare professionals about clinical trial participation.