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Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure

Citation

Stewart, S and Vandenbroeck, AJ and Pearson, S and Horowitz, JD, Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure, Archives of Internal Medicine, 159, (3) pp. 257-61. ISSN 0003-9926 (1999) [Refereed Article]

Copyright Statement

Copyright 1999 American Medical Association

DOI: doi:10.1001/archinte.159.3.257

Abstract

BACKGROUND: A single home-based intervention (HBI) applied immediately after hospital discharge in a cohort of "high-risk" patients with congestive heart failure has been shown to decrease numbers of unplanned readmissions plus out-of-hospital deaths during a period of 6 months. The duration of this beneficial effect remains uncertain. METHODS: Hospitalized patients with congestive heart failure who had been randomly assigned to receive either usual care (n=48) or HBI 1 week after discharge (n=49) were subject to an extended follow-up of 18 months. The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths. Secondary end points included total hospital stay, frequency of multiple readmissions, cost of hospital-based care, and total mortality. RESULTS: During 18-month follow-up, HBI patients had fewer unplanned readmissions (64 vs 125; P=.02) and out-of-hospital deaths (2 vs 9; P=.02), representing 1.4+/-1.3 vs 2.7+/-2.8 events per HBI and usual-care patient, respectively (P=.03). The HBI patients also had fewer days of hospitalization (2.5+/-2.7 vs 4.5+/-4.8 per patient; P=.004) and, once readmitted, were less likely to experience 4 or more readmissions (3/31 vs 12/38; P=.03). Hospital-based costs were significantly lower among HBI patients (Aust $5100 vs Aust $10600 per patient; P=.02). Unplanned readmission was positively correlated with 14 days or more of unplanned readmission in the 6 months before study entry (odds ratio [OR], 5.4; P=.006). Positive correlates of death were (1) non-English speaking (OR, 4.9; P=.008), (2) 14 days or more of unplanned readmission in the 6 months before study entry (OR, 4.9; P=.008), and (3) left ventricular ejection fraction of 40% or less (OR, 3.0; P=.03); conversely, assignment to HBI was a negative correlate (OR, 0.3; P=.02). CONCLUSIONS: In this controlled study, among a cohort of high-risk patients with congestive heart failure, beneficial effects of a postdischarge HBI were sustained for at least 18 months, with a significant reduction in unplanned readmissions, total hospital stay, hospital-based costs, and mortality.

Item Details

Item Type:Refereed Article
Keywords:congestive heart failure, home-based intervention
Research Division:Medical and Health Sciences
Research Group:Public Health and Health Services
Research Field:Aged Health Care
Objective Division:Health
Objective Group:Health and Support Services
Objective Field:Evaluation of Health Outcomes
Author:Pearson, S (Dr Sue Pearson)
ID Code:83233
Year Published:1999
Web of Science® Times Cited:149
Deposited By:Medicine (Discipline)
Deposited On:2013-03-06
Last Modified:2013-06-24
Downloads:0

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