Extending the horizon in chronic heart failure: effects of multidisciplinary, home-based intervention relative to usual care

Inglis, S.C., Pearson, S., Treen, S., Gallasch, T., Horowitz, J.D. and Stewart, S. (2006) Extending the horizon in chronic heart failure: effects of multidisciplinary, home-based intervention relative to usual care. Circulation, 114(23), pp. 2466-2473. (doi: 10.1161/CIRCULATIONAHA.106.638122)

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Abstract

BACKGROUND: The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown. METHODS AND RESULTS: The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04+/-3.23 versus 3.66+/-7.62 admissions; P<0.05) and related hospital stay (14.8+/-23.0 versus 28.4+/-53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of 1729 dollars per additional life-year gained when we accounted for healthcare costs including the HBI. CONCLUSIONS: In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Inglis, Dr Sally
Authors: Inglis, S.C., Pearson, S., Treen, S., Gallasch, T., Horowitz, J.D., and Stewart, S.
Subjects:R Medicine > RC Internal medicine
College/School:College of Medical Veterinary and Life Sciences
Journal Name:Circulation
ISSN:0009-7322

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