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  (ERA 2012 Listed)    (ERA 2010 Rank A)   Check publisher's open access policy
Publication date 2005
Sub-type Review of research - research literature review (NOT book review
DOI 10.1016/j.ejheart.2004.10.008
Volume number 7
Issue number 3
ISSN 1388-9842
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: Review of research - research literature review (NOT book review
Collections: 2006 Higher Education Research Data Collection
School of Nursing and Midwifery Publications
 
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