title: 'Hospital at home' care model as an effective alternative in the management of decompensated chronic heart failure.
abstract: OBJECTIVE
  The 'Hospital at home' (HaH) model avoids hospital admission by transferring healthcare and treatment to the patient's home. We aimed to compare the effectiveness and direct healthcare costs of treating elderly patients with decompensated heart failure (HF) using HaH care vs. inpatient hospital care (IHC) in a cardiology unit.
  
  
  RESULTS
  Eighty patients aged over 65 years who presented at the emergency department with decompensated HF were randomly assigned to IHC or HaH. All patients were studied for 1 year. Seventy-one patients completed the study, of these 34 were admitted to cardiology and 37 received HaH care. No significant differences were found in baseline characteristics, including comorbidity, functional status, and health-related quality of life. Clinical outcomes were similar after initial admission and also after the 12 months of follow-up. Death or re-admission due to HF or another cardiovascular event occurred in 19 patients in IHC and 20 in HaH (P = 0.88). Changes in functional status and health-related quality of life over the follow-up period were not significantly different. The average cost of the initial admission was 4502 +/- 2153 euro in IHC and 2541 +/- 1334 euro in HaH (P < 0.001). During 12 months of follow-up, the average expenditure was 4619 +/- 7679 euro and 3425 +/- 4948 euro (P = 0.83) respectively.
  
  
  CONCLUSIONS
  Hospital at home care allows an important reduction in the costs during the index episode compared with hospital care, whilst maintaining similar outcomes with respect to cardiovascular mortality and morbidity and quality of life at 1 year follow-up.
authors.affiliation: Internal Medicine Service of Hospital Nuestra Señora de Sonsoles, Avila, Spain.
authors.forename: Humberto
authors.initials: H
authors.lastname: Mendoza
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Martín
authors.forename: Angel
authors.initials: A
authors.lastname: García
authors.forename: Fernando
authors.initials: F
authors.lastname: Arós
authors.forename: Felipe
authors.initials: F
authors.lastname: Aizpuru
authors.forename: José
authors.initials: J
authors.lastname: Regalado De Los Cobos
authors.forename: María Concepción
authors.initials: MC
authors.lastname: Belló
authors.forename: Pedro
authors.initials: P
authors.lastname: Lopetegui
authors.forename: Juan Miguel
authors.initials: JM
authors.lastname: Cia
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000191:economics / Q000628:therapy*; D018575:Home Care Services, Hospital-Based / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D010359:Patient Readmission; D013030:Spain