The purpose of our study was to determine if a strategy of starting a heart medication (Beta-blocker) before patients leave the hospital and then being seen by a nurse manager would reduce subsequent hospitalizations compared to usual care.

Hypothesis: A nurse-directed heart failure management program with inpatient initiation of beta blockers will improve health outcomes in a vulnerable, predominantly Hispanic and African American population.

Heart failure is a leading cause of death and hospitalization in the US. Designing practical approaches to improving heart failure care is therefore a national health priority. One retrospective study suggested that patients taking beta-blockers while hospitalized for heart failure had a lower risk of rehospitalization at 6-months. One prospective study suggested that starting beta blockers among hospitalized heart failure patients is safe and improves compliance. However, improved outcomes of this approach have not been prospectively demonstrated.

Comparison: Inpatient initiation of the beta-blocker carvedilol coupled with outpatient follow-up with a nurse manager was compared to usual care by internists and cardiologists.

Inclusion Criteria:

• primary hospitalization with heart failure and LVEF < 40%
• patient informed consent has been obtained
• absence of pulmonary congestion
• age > 18 years

Exclusion Criteria:

• End-stage renal or hepatic disease
• Acute myocardial infarction as primary diagnosis during index hospitalization
• Life-expectancy < 6-months
• Contraindication to beta blocker use
• Current beta-blocker therapy
• Planned bypass or valve surgery during index hospitalization