Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care

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dc.contributor.authorStewart, S.
dc.contributor.authorPearson, S.
dc.contributor.authorHorowitz, J.
dc.date.issued1998
dc.description.abstractBackground We examined the effect of a home-based intervention (HBI) on readmission and death among "high-risk" patients with congestive heart failure discharged home from acute hospital care. Methods Hospitalized patients with congestive heart failure and impaired systolic function, intolerance to exercise, and a history of 1 or more hospital admissions for acute heart failure were randomized to either usual care (n=48) or HBI at 1 week after discharge (n=49). Home-based intervention comprised a single home visit (by a nurse and pharmacist) to optimize medication management, identify early clinical deterioration, and intensify medical follow-up and caregiver vigilance as appropriate. The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths within 6 months of discharge. Secondary end points included duration of hospital stay and overall mortality. Results During follow-up, patients in the HBI group had fewer unplanned readmissions (36 vs 63; P=.03) and fewer out-of-hospital deaths (1 vs 5; P=.11): 0.8±0.9 vs 1.4±1.8 (mean±SD) events per patient assigned to HBI and usual care, respectively (P=.03). Patients in the HBI group also had fewer days of hospitalization (261 vs 452; P=.05) and fewer total deaths (6 vs 12; P=.11). Patients assigned to usual care were more likely to experience 3 or more readmissions for acute heart failure (P=.02). Predictors of unplanned readmission were (1) 14 days or more of unplanned readmission during the 6 months before study entry (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.8-16.2), (2) previous admission for acute myocardial ischemia (OR, 3.3; 95% CI, 1.2-9.1), and (3) an albumin plasma concentration of 38 g/L or less (OR, 2.4; 95% CI, 1.2-6.0). Home-based intervention was also associated with a trend toward reduced risk of unplanned readmission (OR, 0.4; 95% CI, 0.2-1.1). Conclusion Among a cohort of high-risk patients with congestive heart failure, HBI was associated with reduced frequency of unplanned readmissions plus out-of-hospital deaths within 6 months of discharge from the hospital.
dc.description.statementofresponsibilitySimon Stewart, Sue Pearson, John D. Horowitz
dc.identifier.citationArchives of Internal Medicine, 1998; 158(10):1067-1072
dc.identifier.doi10.1001/archinte.158.10.1067
dc.identifier.issn0003-9926
dc.identifier.issn1538-3679
dc.identifier.orcidStewart, S. [0000-0001-9032-8998]
dc.identifier.orcidHorowitz, J. [0000-0001-6883-0703]
dc.identifier.urihttp://hdl.handle.net/2440/8616
dc.language.isoen
dc.publisherAMER MEDICAL ASSOC
dc.rights© American Medical Association. All Rights Reserved.
dc.source.urihttps://doi.org/10.1001/archinte.158.10.1067
dc.subjectHumans
dc.subjectMyocardial Ischemia
dc.subjectAcute Disease
dc.subjectSerum Albumin
dc.subjectAftercare
dc.subjectLength of Stay
dc.subjectPatient Discharge
dc.subjectPatient Readmission
dc.subjectOdds Ratio
dc.subjectRisk
dc.subjectFollow-Up Studies
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectMiddle Aged
dc.subjectHome Care Services
dc.subjectSouth Australia
dc.subjectFemale
dc.subjectMale
dc.subjectHeart Failure
dc.titleEffects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care
dc.typeJournal article
pubs.publication-statusPublished

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