Heart failure or HF patients need a more comprehensive care whether it is in the nursing home or in a home care setting. It is because as of now there are only a few alternatives available for such patients especially who have reached the end stage. The two common treatments available for the HF patients are:

• Inotropic therapy and 

• Left Ventricular Assist Devices. 

However, if you look into the future of health care, there is a significant promise made different treatment and care options such as:

• Availability of several new pharmaceuticals

• Better availability of donor organs

• More erudite mechanical devices to use such as heart pumps and

• Advent of the stem cell and gene therapies.

Now patients therefore do not have to rely on the use of natriuretic peptides only that are not only expensive but the use of these medications is controversial as well. 

The new pharmaceutical agents are conducting ongoing research with several medications in the open as well as in the pipeline such as:

• Calcium sensitizers

• Na–K ATPase agents

• Free fatty acid metabolism modulators 

• Sarcolemmal calcium receptor and 

• Cardiac myosin activators.

However, in spite of all these possibilities and care processes, the most significant areas in treating HF patients that show the greatest promise of all for long-term success are the stem cell and gene therapies. 

• Stem cells have the potential to grow into several differentiated cell types. The one and only goal of this type of therapy is to replace the dead tissues from an AMI with the new viable tissue. This will in turn improve the functioning of the heart. Stem cells can be easily prepared from a heart biopsy. Once it is manipulated it can also be re-infused back into the heart very easily.

• Gene therapy on the other hand, is the specific process by which the defective genes can be changed to rectify the functioning of a specific organ. It is required to deliver the genes to the diseased organ through virus vectors or infusions. The calcium up-regulation by percutaneous management of the gene therapy trial has however completed the phase II of testing just recently.

However, as off now, these treatments are not available for the general public outside of clinical trials.

Providing care to the HF patients beyond meeting the regulatory requirements is a significant challenge for the home health care providers. This is because the HF patients are more vulnerable to medication discrepancies. It is for this reason the home health care agencies should conduct a further and more rigorous medication reconciliation as compared to other patients ailing with different types of issues.

This ideally happens to be the key process in home healthcare and the providers therefore have to serve a crucial role in the post-acute setting especially. Since they are the primary care providers who are responsible for helping the HF patients remain healthy enough so that they can receive the after care in their own homes they also have to follow a few other specific steward health care jobs to do such as:

• Enhance the patient self-care

• Provide better and more effective self-management

• Assess and monitor their medical conditions

• Reduce patient visits to emergency departments and 

• Eliminate the chances of unplanned hospital admissions.

According to the American Society of Health-System Pharmacists and the American Pharmacists Association, the role of the home healthcare providers is to have unique perspectives into the daily needs of HF patients. This will ensure that the continuum of care is maintained from the inpatient settings to the outpatient primary care settings and eventually to the home care setting. 

This is however a critical framework because the home healthcare patients often experience multiple comorbidities. Therefore, in most of the times they need multiple healthcare providers that includes:

• The primary care provider

• A specialist

• The home healthcare provider and more.

They work in perfect tandem to ensure that the conditions of the HF patient are managed most effectively and efficiently to ensure a safe and good result. This once again makes the medication reconciliation process in the home care setting crucial for ensuring patient safety as well as the guaranteed optimal health outcomes.

Therefore, medication reconciliation has a lot of implications for the home healthcare providers.

As said earlier, providing the best and most appropriate care to the HF patients is very challenging and often cannot be met by the home health care providers. This is due to the fact that more often than not the information transferred about the HF patient is not adequate across settings.

However, this is essential to ensure better and proper transition of the patient between different care settings and facilities. The primary reasons for such disconnect in information are:

• Lack of a standardized form for describing the current status of the patients and medications required and 

• Poor communication between the discharging and the receiving facilities.

This means that the receiving facility will often have information about the patient that is outdated, inaccurate, and even missing in some parts, especially regarding the medical history and medications of the patient.

This will hinder the ability of the home health care providers to correctly assess the condition of the patient and the appropriateness of a medication regime. A study conducted by Bowles et al on the use of evidence-based ailment management guidelines in home care for HF patients and diabetes showed that:

• 58% of heart failure patients were found not to be on an angiotensin-converting enzyme or ACE inhibitor and that

• More than 41% of those patients did not have any well-documented justification for such lack of treatment.

Therefore, lack of patient knowledge by the home care providers resulted in inaccurate engagement and care that only compounded the problem. Ad to that, the patients too cannot provide adequate and accurate info about their current medication schedule to the healthcare providers which made home healthcare setting all the more difficult and challenging.

To sum up, the lack of information about the HF patients results eventually into the lack of role clarity of the home care professionals leaving the medication discrepancies unaddressed.