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Type: Journal article
Title: Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial
Author: Scuffham, P.
Ball, J.
Horowitz, J.
Wong, C.
Newton, P.
Macdonald, P.
McVeigh, J.
Rischbieth, A.
Emanuele, N.
Carrington, M.
Reid, C.
Chan, Y.
Stewart, S.
Citation: European Heart Journal, 2017; 38(30):2340-2348
Publisher: Oxford University Press
Issue Date: 2017
ISSN: 0195-668X
Statement of
P.A. Scuffham, J. Ball, J.D. Horowitz, C.Wong, P.J. Newton, P. Macdonald, J. McVeigh, A. Rischbieth, N. Emanuele, M.J. Carrington, C.M. Reid, Y.K. Chan and S. Stewart, on behalf of the WHICH II Trial Investigators
Abstract: Aims: To determine if an intensified form of heart failure management programme (INT-HF-MP) based on individual profiling is superior to standard management (SM) in reducing health care costs during 12-month follow-up (primary endpoint). Methods and Results: A multicentre randomized trial involving 787 patients (full analysis set) discharged from four tertiary hospitals with chronic HF who were randomized to SM (n = 391) or INT-HF-MP (n = 396). Mean age was 74 ± 12 years, 65% had HF with a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling. Study groups were well matched. According to Green, Amber, Red Delineation of rIsk And Need in HF (GARDIAN-HF) profiling, regardless of location, patients in the INT-HF-MP received a combination of face-to-face (home visits) and structured telephone support (STS); only 9% (`low risk') were designated to receive the same level of management as the SM group. The median cost in 2017 Australian dollars (A$1 equivalent to ∼EUR €0.7) of applying INT-HF-MP was significantly greater than SM ($152 vs. $121 per patient per month; P < 0.001), However, at 12 months, there was no difference in total health care costs for the INT-HF-MP vs. SM group (median $1579, IQR $644 to $3717 vs. $1450, IQR $564 to $3615 per patient per month, respectively). This reflected minimal differences in all-cause mortality (17.7% vs. 18.4%; P = 0.848) and recurrent hospital stay (18.6 ± 26.5 vs. 16.6 ± 24.8 days; P = 0.199) between the INT-HF-MP and SM groups, respectively. Conclusion: During 12-months follow-up, an INT-HF-MP did not reduce healthcare costs or improve health outcomes relative to SM.
Keywords: Heart failure; nurse-led; multidisciplinary management; healthcare costs; hospitalization; mortality
Rights: ©The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact
DOI: 10.1093/eurheartj/ehx259
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