title: Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure.
abstract: The purpose of this study was to examine the impact of intensive home-care surveillance on morbidity rates of elderly patients with severe congestive heart failure. Forty-two patients aged 78 +/- 8 years who had severe congestive heart failure (New York Heart Association functional classes III through IV, mean ejection fraction 27% +/- 6%), were examined at least once a week at home by internists from the district hospital and by a trained paramedical team. The year before entry to the home-care program was compared to the first year of home surveillance. The mean total hospitalization (hosp) rate was reduced from 3.2 +/- 1.5 hosp/yr to 1.2 +/- 1.6 hosp/yr and duration from 26 +/- 14 days/yr to 6 +/- 7 days/yr (p < 0.001 for both). Cardiovascular admissions decreased from 2.9 +/- 1.5 hosp/yr to 0.8 +/- 1.1 hosp/yr and duration from 23 +/- 13 days/yr to 4 +/- 4 days/yr (p < 0.001). The vital status (ability to perform daily activities, expressed in a 1 to 4 scale) was improved from 1.4 +/- 0.9 to 2.3 +/- 0.7 (p < 0.001). In conclusion, an intensive home-care program was associated with a marked decrease in the need for hospitalization and improved the functional status of elderly patients with severe congestive heart failure. Such a service might also have a cost-effective advantage and a major impact on health expenditure.
authors.affiliation: Department of Medicine T, Tel Aviv Elias Sourasky Medical Center, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Kornowski
authors.forename: D
authors.initials: D
authors.lastname: Zeeli
authors.forename: M
authors.initials: M
authors.lastname: Averbuch
authors.forename: A
authors.initials: A
authors.lastname: Finkelstein
authors.forename: D
authors.initials: D
authors.lastname: Schwartz
authors.forename: M
authors.initials: M
authors.lastname: Moshkovitz
authors.forename: B
authors.initials: B
authors.lastname: Weinreb
authors.forename: R
authors.initials: R
authors.lastname: Hershkovitz
authors.forename: D
authors.initials: D
authors.lastname: Eyal
authors.forename: M
authors.initials: M
authors.lastname: Miller
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006699:Home Care Services / Q000191:economics; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009017:Morbidity; D010343:Patient Admission / Q000706:statistics & numerical data*