title: Heart failure care in a hospital unit: a comparison of standard 3-month and extended 6-month programs.
abstract: BACKGROUND
  We have previously shown that a structured in-hospital and outpatient heart failure (HF) program reduces clinical events over a 3-month period following hospital discharge.
  
  
  OBJECTIVE
  This prospective randomized controlled study examines the additional benefits of extending the standard 3-month HF program to 6 months on death and readmission over a 2-year follow-up period.
  
  
  METHODS
  Of 161 patients admitted with NYHA class IV HF who completed the standard 3-month HF program, 130 consenting patients (mean age 69.9+/-12.2 years, 65% male) were randomized to the extended 6-month HF program (EP; n=62) or standard care (SP; n=68). The primary endpoint was death and/or unplanned rehospitalization for HF at 2 years postrandomization.
  
  
  RESULTS
  In the 2-year follow-up period, there were eight people with unplanned hospitalizations for HF and 16 deaths in the EP group (event rate 38.7%) compared to seven people with unplanned HF readmissions and 14 deaths in the SP group (event rate 30.9%, p=0.348 versus EP). Kaplan-Meier survival analysis demonstrated no difference in outcome between standard and extended program (p=0.315). There were no differences between the groups in terms of unscheduled clinic visits or non-HF-related readmissions in the 2-year follow-up period.
  
  
  CONCLUSIONS
  There is no measured clinical advantage in terms of death and/or HF readmission in extending a structured hospital-based disease management program for HF beyond 3 months postdischarge. However, it appears that patients continue to need access to the service to help abort clinical deteriorations, and this may have implication for the optimal organisation of such programs.
authors.affiliation: St Vincent's University Hospital HF Unit, Elm Park, Dublin 4, Ireland.
authors.forename: Mark
authors.initials: M
authors.lastname: Ledwidge
authors.forename: Enda
authors.initials: E
authors.lastname: Ryan
authors.forename: Christina
authors.initials: C
authors.lastname: O'Loughlin
authors.forename: Mary
authors.initials: M
authors.lastname: Ryder
authors.forename: Bronagh
authors.initials: B
authors.lastname: Travers
authors.forename: Emma
authors.initials: E
authors.lastname: Kieran
authors.forename: Allison
authors.initials: A
authors.lastname: Walsh
authors.forename: Ken
authors.initials: K
authors.lastname: McDonald
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors