2010

Authors

  • Simon Stewart Simon Stewart
  • Melinda J. Carrington Melinda J. Carrington
  • Thomas H. Marwick Thomas H. Marwick
  • Patricia M. Davidson Patricia M. Davidson
  • Peter Macdonald Peter Macdonald
  • John D. Horowitz John D. Horowitz
  • Henry Krum Henry Krum
  • Phillip J. Newton Phillip J. Newton
  • Christopher Reid Christopher Reid
  • Yih Kai Chan Yih Kai Chan
  • Paul Scuffham Paul Scuffham

Objectives The goal of this study was to make a head-to-head comparison of 2 common forms of multidiscipliry chronic heart failure (CHF) magement. Background Although direct patient contact appears to be best in delivering CHF magement overall, the precise form to optimize health outcomes is less clear. Methods This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71  14 years, and 73% with left ventricular ejection fraction 45%) randomized to home-based intervention (HBI) or specialized CHF clinic-based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs. Results The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio [HR]: 0.97 [95% confidence interval (CI): 0.73 to 1.30], p  0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p  0.887), and 31 (21.7%) versus 38 (27.7%) died (p  0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 [interquartile range (IQR): 2.0 to 7.0] days vs. 6.0 [IQR: 3.5 to 13] days; p  0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 [95% CI: 1.37 to 4.73], p  0.003). HBI was associated with significantly fewer days of all-cause hospitalization (35%; p  0.003) and from cardiovascular causes (37%; p  0.025) but not for CHF (24%; p  0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 [IQR: 13 to 81] per day vs. $AU52 [17 to 140] per day; p  0.030). Conclusions HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was associated with significantly lower healthcare costs, attributable to fewer days of hospitalization.