Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort

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

Research output: Contribution to journalArticle

Abstract

Objectives We compared the longer-term impact of the two most commonly applied forms of post-discharge management designed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure (CHF). Methods We followed a multi-center randomized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 ± 216 days. Blinded endpoints included event-free survival from all-cause emergency hospitalization or death, all-cause mortality and rate of all-cause hospitalization and stay. Results 280 patients (73% male, aged 71 ± 14 years and 73% left ventricular systolic dysfunction) were initially randomized to home-based (n = 143) or clinic-based (n = 137) intervention. During extended follow-up (complete for 274 patients), 1139 all-cause hospitalizations (7477 days of hospital stay) and 121 (43.2%) deaths occurred. There was no difference in the primary endpoint; 20 (14.0%) home-based versus 13 (7.4%) clinic-based patients remained event-free (adjusted HR 0.89, 95% CI 0.70 to 1.15; p = 0.378). Significantly fewer home-based (51/143, 35.7%) than clinic-based intervention (71/137, 51.8%) patients died (adjusted HR 0.62, 95% CI 0.42 to 0.90: p = 0.012). Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations (p = 0.087) associated with 3067 (median 4.0, IQR 2.0 to 6.8) versus 4410 (6.0, IQR 3.0 to 12.0) days of hospital stay (p < 0.01 for rate and duration of hospital stay). Conclusions Relative to clinic-based intervention, home-based intervention was not associated with prolonged event-free survival. Home-based intervention was, however, associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term. Trial registration Australian New Zealand Clinical Trials Registry number 12607000069459 (http://www.anzctr.org.au/Trial/ Registration/TrialReview.aspx?id=81803)

Original languageEnglish (US)
Pages (from-to)600-610
Number of pages11
JournalInternational Journal of Cardiology
Volume174
Issue number3
DOIs
StatePublished - Jul 1 2014
Externally publishedYes

Keywords

  • Chronic heart failure
  • Disease management programs
  • Readmission
  • Survival

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Stewart, S., Carrington, M. J., Horowitz, J. D., Marwick, T. H., Newton, P. J., Davidson, P. M., Macdonald, P., Thompson, D. R., Chan, Y. K., Krum, H., Reid, C., & Scuffham, P. A. (2014). Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort. International Journal of Cardiology, 174(3), 600-610. https://doi.org/10.1016/j.ijcard.2014.04.164