Throughout the hospitalization as appropriate, before hospital discharge, at the rst postdischarge visit, and in Table 23. Recommendations for Hospital Discharge Recommendations or Indications COR LOE References Performance improvement systems in the hospital and early postdischarge outpatient setting to identify HF for GDMT I B 151,332 338 Before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed: a. initiation of GDMT if not done or contraindicated; b. causes of HF, barriers to care, and limitations in support; c. assessment of volume status and blood pressure with adjustment of HF therapy; d. optimization of chronic oral HF therapy; e. renal function and electrolytes; f. management of comorbid conditions; g. HF education, self-care, emergency plans, and adherence; and h. palliative or hospice care I B 57,337,339 341 Multidisciplinary HF disease management for patients at high risk for hospital readmission I B 336,342 344 A follow-up visit within 7 to 14 d and a telephone follow-up within 3 d of hospital discharge are reasonable IIa B 345,346 Use of clinical risk-prediction tools and/or biomarkers to identify higher-risk patients are reasonable IIa B 62 OR indicates Class of Recommendation; GDMT, guideline-directed medical therapy; HF, heart failure; and LOE, Level of Evidence. Yancy et al. JACC Vol. 62, No. 16, 2013 2013 ACCF/AHA Heart Failure Guidelines: Executive Summary October 15, 2013:1495 539 subsequent follow-up visits, the following should be addressed (57,337,339 341). 