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Type: Journal article
Title: Effects of a multidisciplinary, home-based intervention on planned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study
Author: Stewart, S.
Marley, J.
Horowitz, J.
Citation: The Lancet, 1999; 354(9184):1077-1083
Publisher: Elsevier
Issue Date: 1999
ISSN: 0140-6736
Statement of
Simon Stewart, John E Marley, John D Horowitz
Abstract: <h4>Background</h4>Hospital admissions among patients with congestive heart failure (CHF) are a major contributor to health-care costs. Previous investigations suggest that the therapeutic efficacy of pharmacotherapy in CHF may be improved by strategies incorporating home visits to identify and address factors precipitating deterioration and resultant readmission.<h4>Methods</h4>Chronic CHF patients discharged home after acute hospital admission were randomly assigned usual care (n=100) or a multidisciplinary, home-based intervention (n=100), consisting of a home visit by a cardiac nurse 7-14 days after discharge. The primary endpoint of the study was frequency of unplanned readmission plus out-of-hospital death within 6 months.<h4>Findings</h4>During 6 months' follow-up there were 129 primary endpoint events in the usual-care group and 77 in the intervention group (p=0.02). More intervention-group than usual-care patients remained event-free (38 vs 51; p=0.04). Overall, there were fewer unplanned readmissions (68 vs 118; p=0.03) and associated days in hospital (460 vs 1173; p=0.02) among intervention-group patients. Hospital-based costs were Australian $490,300 for the intervention group and A$922,600 for the usual-care group (p=0.16); the mean cost of the intervention was A$350 per patient, and other community-based costs were similar for both groups.<h4>Interpretation</h4>A home-based intervention has the potential to decrease the rate of unplanned readmissions and associated health-care costs, prolong event-free and total survival, and improve quality of life among patients with chronic CHF.
Keywords: Humans
Chronic Disease
Patient Readmission
Survival Analysis
Quality of Life
Middle Aged
Home Care Services
Health Care Costs
Heart Failure
Surveys and Questionnaires
Rights: © 1999 Elsevier Ltd. All rights reserved.
DOI: 10.1016/S0140-6736(99)03428-5
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