title: Home-based intervention in congestive heart failure: long-term implications on readmission and survival.
abstract: BACKGROUND
  It is not known to what extent initially observed benefits of postdischarge programs of care for patients with chronic congestive heart failure (CHF) in respect to event-free survival, readmissions, and healthcare costs persist in the long term. Methods and Results- We prospectively studied the long-term effects of a multidisciplinary home-based intervention (HBI) in a cohort of CHF patients randomly allocated to either to HBI (n=149) or usual care (n=148). During a median of 4.2 years of follow-up, there were significantly fewer primary end points (unplanned readmission or death) in the HBI versus usual care group: a mean of 0.21 versus 0.37 primary events per patient per month (P<0.01). Median event-free survival was more prolonged in the HBI than usual care group (7 versus 3 months; P<0.01). Fewer HBI patients died (56% versus 65%; P=0.06) and had more prolonged survival (a median of 40 versus 22 months; P<0.05) compared with usual care. Assignment to HBI was both an independent predictor of event-free survival (RR 0.70; P<0.01) and survival alone (RR 0.72; P<0.05). Overall, HBI patients had 78 fewer unplanned readmissions compared with usual care (0.17 versus 0.29 readmissions per patient per month; P<0.05). The median cost of these readmissions was $A325 versus $A660/month per HBI and usual care patient (P<0.01).
  
  
  CONCLUSIONS
  The beneficial effects of HBI in reducing frequency of unplanned readmissions in CHF patients persist in the long term and are associated with prolongation of survival.
authors.affiliation: Division of Health Sciences, University of South Australia. simon.stewart@unisa.edu.au
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
mesh_terms: D000359:Aftercare; D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006333:Heart Failure / Q000191:economics / Q000401:mortality* / Q000628:therapy*; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D016019:Survival Analysis; D013995:Time