Improved cost-effectiveness for management of chronic heart failure by combined home-based intervention with clinical nursing specialists.
OBJECTIVE
The influence of home- and clinic-based caring system on the economic burden of heart failure remains unknown.


METHODS
Between January 2004 and December 2004, chronic heart failure patients who were followed up by specialist nurse-led telephone visiting regularly were enrolled. Clinical and economic data half a year before enrollment were collected as control.


RESULTS
A total of 247 patients (168 males, 79 females; mean age, 60 +/- 17 years) were enrolled. The mean follow-up period was 139 +/- 96 days. The mean left ventricular ejection fraction was 35%. There were 1618 times of specialist nurse-led telephone visiting (average 8 +/- 6 times/patient). The mortality rate was 5.7%. Before enrollment, the total hospitalization fees were 624,020 US dollars. After enrollment, the cost was reduced to 362,722 US dollars (41.8% reduction). The mean functional class (New York Heart Association) also improved from 2.27 +/- 0.80 to 1.9 6 +/- 0.90 (p < 0.001). The mean duration of hospital stay due to heart failure was reduced by 5.3 days (26.2% decrement). The total numbers of admission were reduced to 36 times (33.0% decrement). The readmission rate due to etiologies other than heart failure (such as infection, gastrointestinal bleeding, etc.) was reduced from 15.9% to 7.7%. The total fees of visiting emergency station were reduced from 6528 US dollars to 6101 US dollars (6.5% decrement). On the other hand, the frequency of visiting the outpatient department (OPD) increased from 5.2 +/- 3.2 to 6.6 +/- 4.1 times/patient (p < 0.001). The total fees of visiting OPD increased from 90,783 US dollars to 94,855 US dollars(4.4% increment).


CONCLUSIONS
The home- and clinic-based caring system is capable of decreasing adverse outcomes, most notably hospitalization and length of stay, and could trigger significant cost savings in the management of heart failure.
Ho
Yi-Lwun
YL
Graduate Institute of Clinical Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Hsu
Tse-Pin
TP
Chen
Chiou-Ping
CP
Lee
Chu-Yuan
CY
Lin
Yen-Hung
YH
Hsu
Ron-Bin
RB
Wu
Yen-Wen
YW
Chou
Nai-Kuan
NK
Lee
Chi-Ming
CM
Wang
Shoei-Shen
SS
Ting
Hsiu-Tzu
HT
Chen
Ming-Fong
MF
D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000451:nursing*; D018575:Home Care Services, Hospital-Based / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians; D010359:Patient Readmission / Q000706:statistics & numerical data; D012044:Regression Analysis; D016896:Treatment Outcome