TY - JOUR
T1 - The WHICH? Trial
T2 - Rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients
AU - Stewart, Simon
AU - Carrington, Melinda J.
AU - Marwick, Thomas
AU - Davidson, Patricia M.
AU - MacDonald, Peter
AU - Horowitz, John
AU - Krum, Henry
AU - Newton, Phillip J.
AU - Reid, Christopher
AU - Scuffham, Paul A.
PY - 2011/8
Y1 - 2011/8
N2 - Aims To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. Methods WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patients own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 1218 months of follow-up. Of 688 eligible patients, 280 patients (73 male and 66 principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n 143) or clinic-based (n 137) post-discharge management. This will provide 80 power (two-sided alpha of 0.05) to detect a 15 absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63), coronary artery disease (55), and atrial fibrillation (53) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Perspective Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients. Published on behalf of the European Society of Cardiology. All rights reserved.
AB - Aims To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. Methods WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patients own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 1218 months of follow-up. Of 688 eligible patients, 280 patients (73 male and 66 principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n 143) or clinic-based (n 137) post-discharge management. This will provide 80 power (two-sided alpha of 0.05) to detect a 15 absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63), coronary artery disease (55), and atrial fibrillation (53) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Perspective Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients. Published on behalf of the European Society of Cardiology. All rights reserved.
KW - Chronic heart failure
KW - Disease management
KW - Left ventricular systolic dysfunction
UR - http://www.scopus.com/inward/record.url?scp=79961055835&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79961055835&partnerID=8YFLogxK
U2 - 10.1093/eurjhf/hfr048
DO - 10.1093/eurjhf/hfr048
M3 - Review article
C2 - 21616952
AN - SCOPUS:79961055835
SN - 1388-9842
VL - 13
SP - 909
EP - 916
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 8
ER -