Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/35712
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Type: Journal article
Title: Extending the horizon in chronic heart failure: Effects of multidisciplinary, home-based intervention relative to usual care
Author: Inglis, S.
Pearson, S.
Treen, S.
Gallasch, T.
Horowitz, J.
Stewart, S.
Citation: Circulation, 2006; 114(23):2466-2473
Publisher: Lippincott Williams & Wilkins
Issue Date: 2006
ISSN: 0009-7322
1524-4539
Statement of
Responsibility: 
Sally C. Inglis, Sue Pearson, Suzette Treen, Tamara Gallasch, John D. Horowitz, Simon Stewart
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 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.
Keywords: cost-benefit analysis
heart failure
prevention
prognosis
Description: © 2006 American Heart Association, Inc.
DOI: 10.1161/CIRCULATIONAHA.106.638122
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