Exploring the potential to remain "Young @ Heart": initial findings of a multi-centre, randomised study of nurse-led, home-based intervention in a hybrid health care system.
BACKGROUND
Disease management programs have been shown to improve health outcomes in high risk individuals in many but not all health care systems.


METHODS
Young @ Heart is a multi-centre, randomised controlled study of a nurse-led, home-based intervention (HBI) program vs. usual care (UC) in privately insured patients in Australia aged ≥ 45 years following an acute cardiac admission. Intensity of HBI is tailored to an individual's clinical stability, management and risk profile. The primary endpoint is the rate of all-cause stay during a mean of 2.5 years follow-up.


RESULTS
A target of 602 adults (72% men) were randomised to HBI (n=306) or UC (n=296); their initial profiles being well matched. At baseline, 71% were overweight (body mass index 29.7 ± 3.9 kg/m(2)) and 66% had an elevated blood pressure (153 ± 18/89 ± 7 mm Hg). Over half had a history of smoking and 39% had a sub-optimal total cholesterol level >4 mmol/L. Overall, 62% (376 cases) were treated for coronary artery disease (27% with multi-vessel disease and 39% underwent cardiac revascularisation). A further 20% (120 cases) were treated for a cardiac arrhythmia (predominantly atrial fibrillation) and 19% type 2 diabetes mellitus. At 7-14 days post-discharge, 293 (96%) HBI patients received a home visit triggering urgent clinical review and/or enhanced clinical management in many patients.


CONCLUSIONS
The Young @ Heart intervention is a well accepted and potentially effective intervention to reduce recurrent hospital stay in privately insured cardiac patients in Australia.
Chan
Yih-Kai
YK
Preventative Health, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Stewart
Simon
S
Calderone
Alicia
A
Scuffham
Paul
P
Goldstein
Stan
S
Carrington
Melinda J
MJ
D000368:Aged; D003695:Delivery of Health Care / Q000458:organization & administration; D005260:Female; D006331:Heart Diseases / Q000451:nursing*; D006699:Home Care Services; D006801:Humans; D008297:Male; D016037:Single-Blind Method; D013041:Specialties, Nursing