Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure

Thompson, David R., Roebuck, Alun and Stewart, Simon (2005) Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure. European Journal of Heart Failure, 7 3: 377-384.


Author Thompson, David R.
Roebuck, Alun
Stewart, Simon
Title Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure
Journal name European Journal of Heart Failure   Check publisher's open access policy
ISSN 1388-9842
Publication date 2005
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.ejheart.2004.10.008
Volume 7
Issue 3
Start page 377
End page 384
Total pages 8
Place of publication Amsterdam, The Netherlands
Publisher Elsevier BV
Collection year 2005
Language eng
Subject C1
Abstract Background: Few studies have examined the potential benefits of specialist nurse-led programs of care involving home and clinic-based follow-up to optimise the post-discharge management of chronic heart failure (CHF). Objective: To determine the effectiveness of a hybrid program of clinic plus home-based intervention (C+HBI) in reducing recurrent hospitalisation in CHF patients. Methods: CHF patients with evidence of left ventricular systolic dysfunction admitted to two hospitals in Northern England were assigned to a C+HBI lasting 6 months post-discharge (n=58) or to usual, post-discharge care (UC: n=48) via a cluster randomization protocol. The co-primary endpoints were death or unplanned readmission (event-free survival) and rate of recurrent, all-cause readmission within 6 months of hospital discharge. Results: During study follow-up, more UC patients had an unplanned readmission for any cause (44% vs. 22%: P=0.0191 OR 1.95 95% CI 1.10-3.48) whilst 7 (15%) versus 5 (9%) UC and C+HBI patients, respectively, died (P=NS). Overall, 15 (26%) C+HBI versus 21 (44%) UC patients experienced a primary endpoint. C+HBI was associated with a non-significant, 45% reduction in the risk of death or readmission when adjusting for potential confounders (RR 0.55, 95% CI 0.28-1.08: P=0.08). Overall, C+HBI patients accumulated significantly fewer unplanned readmissions (15 vs. 45: P<0.01) and days of recurrent hospital stay (108 vs. 459 days: P<0.01). C+HBI was also associated with greater uptake of beta-blocker therapy (56% vs. 18%: P<0.001) and adherence to Na restrictions (P<0.05) during 6-month follow-up. Conclusion: This is the first randomised study to specifically examine the impact of a hybrid, C+HBI program of care on hospital utilisation in patients with CHF Its beneficial effects on recurrent readmission and event-free survival are consistent with those applying either a home or clinic-based approach. (C) 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.
Keyword Cardiac & Cardiovascular Systems
Chronic Heart Failure
Randomised Trial
Home-based Intervention
Outpatient Clinic
Morbidity
High-risk
Multidisciplinary Care
Management Programs
Randomized-trials
Elderly-patients
Survival
Population
Readmission
Discharge
Prognosis
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: 2006 Higher Education Research Data Collection
School of Nursing and Midwifery Publications
 
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