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The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients


Stewart, S and Carrington, MJ and Marwick, TH and Davidson, PM and Macdonald, P and Horowitz, J and Krum, H and Newton, PJ and Reid, C and Scuffham, PA, The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients, European Journal of Heart Failure, 13, (8) pp. 909-916. ISSN 1388-9842 (2011) [Refereed Article]

Copyright Statement

Copyright 2011 the authors: Simon Stewart, Melinda J. Carrington, Thomas Marwick, Patricia M. Davidson,Peter Macdonald, John Horowitz, Henry Krum, Phillip J. Newton, Christopher Reid, and Paul A. Scuffham.

DOI: doi:10.1093/eurjhf/hfr048


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 patient's 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.

Item Details

Item Type:Refereed Article
Keywords:chronic heart failure, left ventricular systolic dysfunction, disease management
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:90965
Year Published:2011
Web of Science® Times Cited:28
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-05-05
Last Modified:2017-01-09

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