title: Home-based advance care programme is effective in reducing hospitalisations of advanced heart failure patients: a clinical and healthcare cost study.
abstract: BACKGROUND
  In end-stage heart failure (HF) that is not eligible for mechanical assist device or heart transplant, palliative care serves to maximise symptom control and quality of life. We sought to evaluate the impact of home-based advance care programme (ACP) on healthcare utilisation in end-stage HF patients.
  
  
  METHODS
  Prospectively collected registry data on all end-stage HF recruited into ACP between July 2008 and July 2010 were analysed. Chart reviews were conducted on HF database and hospital electronic records. Phone interview and home visit details by ACP team were extracted to complete data entry. HF and all-cause hospitalisations 1 year before, and any time after ACP inception were defined as events. For the latter analysis, follow-up duration adjustment to event episodes was performed to account for death less than a year.
  
  
  RESULTS
  Forty-four patients (mean age 79 years, 39% men) were followed up for 15±8 months. Fifty-seven percent had diabetes, 80% ischaemic heart disease, and 60% chronic kidney disease. All reported functional class III/IV at enrolment. Mean serum sodium was 136±6 mmol/L, and creatinine 186±126 mmol/L. Thirty (68%) died within the programme. Mean time to death was 5.5 months. Mean all-cause and HF hospitalisations were 3.6 and 2.0 per patient before enrolment, but improved to 1.0 and 0.6 respectively after ACP. Thirty-six (71%) patients had fewer HF hospitalisations. When only those who survived more than a year were considered (n = 14), 10 (71%) and 9 (64%) experienced reduced HF (mean: 1.4 episodes per patient) and all-cause hospitalisations (mean: 2.2 episodes per patient) respectively.
  
  
  CONCLUSIONS
  Home-based advance care programme is potentially effective in reducing healthcare utilisation of end-stage HF patients, primarily by reducing HF rehospitalisations, and in probably saving costs as well.
authors.affiliation: Cardiac Department, National University Heart Centre Singapore, National University Hospital, Singapore.
authors.forename: Raymond Cc
authors.initials: RC
authors.lastname: Wong
authors.forename: Poh Tin
authors.initials: PT
authors.lastname: Tan
authors.forename: Yen Hoon
authors.initials: YH
authors.lastname: Seow
authors.forename: Suzana
authors.initials: S
authors.lastname: Aziz
authors.forename: Nilar
authors.initials: N
authors.lastname: Oo
authors.forename: Swee Chong
authors.initials: SC
authors.lastname: Seow
authors.forename: Angeline
authors.initials: A
authors.lastname: Seah
authors.forename: Ping
authors.initials: P
authors.lastname: Chai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus; D005260:Female; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000150:complications / Q000191:economics / Q000628:therapy*; D018575:Home Care Services, Hospital-Based / Q000191:economics; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications; D010166:Palliative Care / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000150:complications; D062606:Tertiary Care Centers