title: Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.
abstract: To examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge.
  
  
  
  This was a randomised controlled trial conducted in three hospitals in Hong Kong. The recruited subjects were patients with ESHF who had been discharged home from hospitals and referred for palliative service, and who met the specified inclusion criteria. The interventions consisted of weekly home visits/telephone calls in the first 4 weeks then monthly follow-up, provided by a nurse case manager supported by a multidisciplinary team. The primary outcome measures were any readmission and count of readmissions within 4 and 12 weeks after index discharge, compared using χ(2) tests and Poisson regression, respectively. Secondarily, change in symptoms over time between control and intervention groups were evaluated using generalised estimating equation analyses of data collected using the Edmonton Symptom Assessment Scale (ESAS).
  
  
  
  The intervention group (n=43) had a significantly lower readmission rate than the control group (n=41) at 12 weeks (intervention 33.6% vs control 61.0% χ(2)=6.8, p=0.009). The mean number (SE) of readmissions for the intervention and control groups was, respectively, 0.42 (0.10) and 1.10 (0.16) and the difference was significant (p=0.001). The relative risk (CI) for 12-week readmissions for the intervention group was 0.55 (0.35 to 0.88). There was no significant difference in readmissions between groups at 4 weeks. However, when compared with the control group, the intervention group experienced significantly higher clinical improvement in depression (45.9% vs 16.1%, p<0.05), dyspnoea (62.2% vs 29.0%, p<0.05) and total ESAS score (73.0% vs 41.4%, p<0.05) at 4 weeks. There were significant differences between groups in changes over time in quality of life (QOL) measured by McGill QOL (p<0.05) and chronic HF (p<0.01) questionnaires.
  
  
  
  This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF.
  
  
  
  HKCTR-1562; Results.
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Frances Kam Yuet
authors.initials: FK
authors.lastname: Wong
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Alina Yee Man
authors.initials: AY
authors.lastname: Ng
authors.affiliation: School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Paul Hong
authors.identifier: 0000-0002-5729-6450
authors.initials: PH
authors.lastname: Lee
authors.affiliation: Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China.
authors.forename: Po-Tin
authors.initials: PT
authors.lastname: Lam
authors.affiliation: Department of Medicine, Haven of Hope Hospital, Hong Kong, China.
authors.forename: Jeffrey Sheung Ching
authors.initials: JS
authors.lastname: Ng
authors.affiliation: Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China.
authors.forename: Nancy Hiu Yim
authors.initials: NH
authors.lastname: Ng
authors.affiliation: Palliative Medical Unit, Grantham Hospital, Hong Kong, China.
authors.forename: Michael Mau Kwong
authors.initials: MM
authors.lastname: Sham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D018575:Home Care Services, Hospital-Based; D006723:Hong Kong; D006792:House Calls; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010351:Patient Discharge; D010359:Patient Readmission; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013689:Telephone; D013997:Time Factors; D000069341:Transitional Care; D016896:Treatment Outcome