The goal of the PACT-HF study was for all patients hospitalized with heart failure (HF), in 10 large hospitals in Canada, to receive self-care education, multidisciplinary care services, and early follow-up with their primary health care providers; and for high-risk patients to receive nurse-led home visits and outpatient care in heart function clinics following hospital discharge.

We redesigned workflow to integrate health care services across institutions and regional networks that typically work independently of each other.

We obtained clinical outcomes via linkages to provincial administrative databases, analyzing them using shared frailty survival models adjusted for the stepped wedge design.

We analyzed secondary outcomes using hierarchical models adjusted for the stepped wedge design. We applied the Intention-to-treat principle for all analyses.

Primary outcomes:

  • Time to 3-month composite all-cause readmissions, emergency department (ED) visits, and death.
  • 30-day composite all-cause readmissions and ED visits.

Secondary outcome:

  • Patient-reported discharge preparedness
  • Care transitions quality
  • Health-related quality of life
  • Quality-adjusted life years
Study Type


Study Design

Stepped wedge cluster RCT

NO. of Countries


NO. of Sites


NO. of Participants


Study Period




Canadian Institutes of Health Research (CIHR)

Ministry of Health and Long Term Care

VIDEO: Harriette Van Spall on PACT-HF at AHA 2019

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