Extending the horizon in chronic heart failure: effects of multidisciplinary, home-based intervention relative to usual care.
BACKGROUND
The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown.


RESULTS
The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04+/-3.23 versus 3.66+/-7.62 admissions; P<0.05) and related hospital stay (14.8+/-23.0 versus 28.4+/-53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of 1729 dollars per additional life-year gained when we accounted for healthcare costs including the HBI.


CONCLUSIONS
In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.
Inglis
Sally C
SC
University of Queensland, Faculty of Health Sciences, Brisbane, Queensland, Australia.
Pearson
Sue
S
Treen
Suzette
S
Gallasch
Tamara
T
Horowitz
John D
JD
Stewart
Simon
S
D000368:Aged; D000369:Aged, 80 and over; D002303:Cardiac Output, Low / Q000191:economics / Q000401:mortality / Q000451:nursing*; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000639:trends; D006699:Home Care Services / Q000191:economics; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D012648:Self Care; D016896:Treatment Outcome