• Nancy M Albert and Marc J Kozinn.
• Nancy M. Albert is associate chief nursing officer, Office of Nursing Research and Innovation, and a clinical nurse specialist, Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. albertn@ccf.org.
• Crit Care Nurse. 2018 Oct 1; 38 (5): 16-24.

AbstractHeart failure is a burdensome cardiovascular condition associated with high rates of morbidity and mortality. The 3-month period after hospitalization is a vulnerable phase in which patients are at high risk for mortality and rehospitalization. To reduce risk during this period, patients with heart failure and reduced ejection fraction should receive guideline-directed pharmacological therapies-the right drugs at the right doses-before hospital discharge. Optimal pharmacotherapies for these patients include agents that suppress the renin-angiotensin-aldosterone system, suppress the sympathetic nervous system, enhance vasodilation, slow heart rate when needed, and reduce excess volume. Because optimal prescription and adherence are both necessary to ensure the best clinical outcomes, nurses need to participate in interventions that optimize prescription and drug use over time. Collaboration with pharmacists and advanced practice acute care nurses may help ensure that medication selection and dosing are consistent with national guidelines. Use of a predischarge order set and electronic medical records checklist can enhance collaborative care.©2018 American Association of Critical-Care Nurses.

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