# Reducing Heart Failure Readmissions Through an Advanced Practice Nurse–Led Clinic With Navigator Support

## TL;DR

A nurse-led clinic with navigator support helps reduce heart failure readmissions and improves patient outcomes.

## Contribution

An Advanced Practice Nurse-led clinic with Heart Failure Navigators significantly reduces readmission rates.

## Key findings

- Readmission rates dropped below national averages through nurse-led care and navigator support.
- Patients showed improved medication adherence and quality of life.
- Proactive monitoring and lifestyle education reduced rehospitalizations.

## Abstract

Acute heart failure is a leading cause of hospital readmissions, with nearly 20% rehospitalized within 30 days. Our institution's rate was over 27%, exceeding the national average.

To reduce readmissions, we launched an Advanced Practice Nurse-led clinic supported by Heart Failure Navigators. The strategy focused on lifestyle education, proactive monitoring, and coordinated care.

Between 2021 and 2024, we followed up with adult patients discharged with New York Heart NYHA functional class II to IV heart failure, implementing telemonitoring, lifestyle coaching, guideline-directed medical therapy, and proactive outreach by Heart Failure Navigators.

Advanced practice nurses, with navigator support, reduce readmissions, boost medication adherence, and improve quality of life and outcomes.