Stewart, S and Carrington, MJ and Marwick, TH and Davidson, PM and Macdonald, P and Horowitz, JD and Krum, H and Newton, PJ and Reid, C and Chan, YK and Scuffham, PA, Impact of home versus clinic-based management of chronic heart failure: the WHICH (which heart failure intervention is most cost-effective & consumer friendly in reducing hospital care) multicenter, randomized trial, Journal of the American College of Cardiology, 60, (14) pp. 1239-1248. ISSN 0735-1097 (2012) [Refereed Article]
Copyright 2012 The American College of Cardiology Foundation
Background Although direct patient contact appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear.
Methods This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71 ± 14 years, and 73% with left ventricular ejection fraction ≤45%) randomized to home-based intervention (HBI) or specialized CHF clinic–based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs.
Results The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio [HR]: 0.97 [95% confidence interval (CI): 0.73 to 1.30], p = 0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p = 0.887), and 31 (21.7%) versus 38 (27.7%) died (p = 0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 [interquartile range (IQR): 2.0 to 7.0] days vs. 6.0 [IQR: 3.5 to 13] days; p = 0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 [95% CI: 1.37 to 4.73], p = 0.003). HBI was associated with significantly fewer days of all-cause hospitalization (−35%; p = 0.003) and from cardiovascular causes (−37%; p = 0.025) but not for CHF (−24%; p = 0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 [IQR: 13 to 81] per day vs. $AU52 [17 to 140] per day; p = 0.030).Conclusions HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was associated with significantly lower healthcare costs, attributable to fewer days of hospitalization.
|Item Type:||Refereed Article|
|Keywords:||disease management, health economics, heart failure|
|Research Division:||Medical and Health Sciences|
|Research Group:||Cardiorespiratory Medicine and Haematology|
|Research Field:||Cardiology (incl. Cardiovascular Diseases)|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Cardiovascular System and Diseases|
|Author:||Marwick, TH (Professor Tom Marwick)|
|Web of Science® Times Cited:||64|
|Deposited By:||Menzies Institute for Medical Research|
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