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Extending the horizon in chronic heart failure: Effects of multidisciplinary, home-based intervention relative to usual care

Citation

Inglis, S and Pearson, S and Treen, S and Galasch, T and Horowitz, JD and Stewart, S, Extending the horizon in chronic heart failure: Effects of multidisciplinary, home-based intervention relative to usual care, Circulation, 114, (23) pp. 2466-2473. ISSN 0009-7322 (2006) [Refereed Article]

DOI: doi:10.1161/CIRCULATIONAHA.106.638122

Abstract

BACKGROUND - The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown. METHODS AND RESULTS - The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04±3.23 versus 3.66±7.62 admissions; P<0.05) and related hospital stay (14.8±23.0 versus 28.4±53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional life-year gained when we accounted for healthcare costs including the HBI. CONCLUSIONS - In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term. © 2006 American Heart Association, Inc.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Nursing
Research Field:Clinical Nursing: Secondary (Acute Care)
Objective Division:Health
Objective Group:Health and Support Services
Objective Field:Nursing
Author:Inglis, S (Ms Inglis)
Author:Pearson, S (Dr Sue Pearson)
ID Code:48902
Year Published:2006
Web of Science® Times Cited:73
Deposited By:Menzies Institute for Medical Research
Deposited On:2007-08-01
Last Modified:2011-09-29
Downloads:0

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