Published online before print May 6, 2002, doi: 10.1161/01.CIR.0000019067.99013.67
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(Circulation. 2002;105:2861.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Home-Based Intervention in Congestive Heart Failure
Long-Term Implications on Readmission and Survival
From the Division of Health Sciences (S.S.), University of South Australia; and the Department of Medicine (J.D.H.), Adelaide University, Adelaide, Australia.
Correspondence to Dr Simon Stewart, School of Nursing and Midwifery/CRNHC, City East Campus, University of South Australia, Frome Road, Adelaide, 5000, Australia. E-mail simon.stewart{at}unisa.edu.au
Background— It is not known to what extent initially observed benefits of postdischarge programs of care for patients with chronic congestive heart failure (CHF) in respect to event-free survival, readmissions, and healthcare costs persist in the long term.
Methods and Results— We prospectively studied the long-term effects of a multidisciplinary home-based intervention (HBI) in a cohort of CHF patients randomly allocated to either to HBI (n=149) or usual care (n=148). During a median of 4.2 years of follow-up, there were significantly fewer primary end points (unplanned readmission or death) in the HBI versus usual care group: a mean of 0.21 versus 0.37 primary events per patient per month (P<0.01). Median event-free survival was more prolonged in the HBI than usual care group (7 versus 3 months; P<0.01). Fewer HBI patients died (56% versus 65%; P=0.06) and had more prolonged survival (a median of 40 versus 22 months; P<0.05) compared with usual care. Assignment to HBI was both an independent predictor of event-free survival (RR 0.70; P<0.01) and survival alone (RR 0.72; P<0.05). Overall, HBI patients had 78 fewer unplanned readmissions compared with usual care (0.17 versus 0.29 readmissions per patient per month; P<0.05). The median cost of these readmissions was $A325 versus $A660/month per HBI and usual care patient (P<0.01).
Conclusions— The beneficial effects of HBI in reducing frequency of unplanned readmissions in CHF patients persist in the long term and are associated with prolongation of survival.
Key Words: congestive heart failure • cardiovascular nursing • health policy • outcome research
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