TY - JOUR
T1 - Prolonged impact of home versus clinic-based management of chronic heart failure
T2 - Extended follow-up of a pragmatic, multicentre randomized trial cohort
AU - Stewart, Simon
AU - Carrington, Melinda J.
AU - Horowitz, John D.
AU - Marwick, Thomas H.
AU - Newton, Phillip J.
AU - Davidson, Patricia M.
AU - Macdonald, Peter
AU - Thompson, David R.
AU - Chan, Yih Kai
AU - Krum, Henry
AU - Reid, Christopher
AU - Scuffham, Paul A.
N1 - Funding Information:
We thank all the cardiac nurses, health care professionals and patients who participated, Alicia Calderone, and staff at Baker IDI who contributed to data management. The WHICH? Trial (Grant number 418967) and SS and MC are supported by the National Health and Medical Research Council (NHMRC) of Australia .
PY - 2014/7/1
Y1 - 2014/7/1
N2 - 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)
AB - 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)
KW - Chronic heart failure
KW - Disease management programs
KW - Readmission
KW - Survival
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U2 - 10.1016/j.ijcard.2014.04.164
DO - 10.1016/j.ijcard.2014.04.164
M3 - Article
C2 - 24825029
AN - SCOPUS:84903270404
SN - 0167-5273
VL - 174
SP - 600
EP - 610
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 3
ER -