Randomized trial of an education and support intervention to prevent readmission of patients with heart failure.
OBJECTIVE
We determined the effect of a targeted education and support intervention on the rate of readmission or death and hospital costs in patients with heart failure (HF).


BACKGROUND
Disease management programs for patients with HF including medical components may reduce readmissions by 40% or more, but the value of an intervention focused on education and support is not known.


METHODS
We conducted a prospective, randomized trial of a formal education and support intervention on one-year readmission or mortality and costs of care for patients hospitalized with HF.


RESULTS
Among the 88 patients (44 intervention and 44 control) in the study, 25 patients (56.8%) in the intervention group and 36 patients (81.8%) in the control group had at least one readmission or died during one-year follow-up (relative risk = 0.69, 95% confidence interval [CI]: 0.52, 0.92; p = 0.01). The intervention was associated with a 39% decrease in the total number of readmissions (intervention group: 49 readmissions; control group: 80 readmissions, p = 0.06). After adjusting for clinical and demographic characteristics, the intervention group had a significantly lower risk of readmission compared with the control group (hazard ratio = 0.56, 95% CI: 0.32, 0.96; p = 0.03) and hospital readmission costs of $7,515 less per patient.


CONCLUSIONS
A formal education and support intervention substantially reduced adverse clinical outcomes and costs for patients with HF.
Krumholz
Harlan M
HM
Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
Amatruda
Joan
J
Smith
Grace L
GL
Mattera
Jennifer A
JA
Roumanis
Sarah A
SA
Radford
Martha J
MJ
Crombie
Paula
P
Vaccarino
Viola
V
D000368:Aged; D003237:Connecticut; D017281:Cost of Illness; D019468:Disease Management; D005260:Female; D006302:Health Services Research; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000191:economics; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies