Prolonged impact of home versus clinic-based management of chronic heart failure: extended follow-up of a pragmatic, multicentre randomized trial cohort

Stewart, Simon, Carrington, Melinda J., Horowitz, John D., Marwick, Thomas H., Newton, Phillip J., Davidson, Patricia M., Macdonald, Peter, Thompson, David R., Chan, Yih-Kai, Krum, Henry, Reid, Christopher and Scuffham, Paul A. (2014) Prolonged impact of home versus clinic-based management of chronic heart failure: extended follow-up of a pragmatic, multicentre randomized trial cohort. International Journal of Cardiology, 174 3: 600-610. doi:10.1016/j.ijcard.2014.04.164

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Author Stewart, Simon
Carrington, Melinda J.
Horowitz, John D.
Marwick, Thomas H.
Newton, Phillip J.
Davidson, Patricia M.
Macdonald, Peter
Thompson, David R.
Chan, Yih-Kai
Krum, Henry
Reid, Christopher
Scuffham, Paul A.
Title Prolonged impact of home versus clinic-based management of chronic heart failure: extended follow-up of a pragmatic, multicentre randomized trial cohort
Journal name International Journal of Cardiology   Check publisher's open access policy
ISSN 0167-5273
1874-1754
Publication date 2014-06-01
Sub-type Article (original research)
DOI 10.1016/j.ijcard.2014.04.164
Open Access Status Not Open Access
Volume 174
Issue 3
Start page 600
End page 610
Total pages 11
Place of publication E. Park, Shannon, Co. Clare, Ireland
Publisher Elsevier Ireland
Language eng
Formatted abstract
Objectives We compared the longer-term impact of the two most commonly applied forms of post-discharge management designed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure (CHF).

Methods We followed a multi-center randomized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 ± 216 days. Blinded endpoints included event-free survival from all-cause emergency hospitalization or death, all-cause mortality and rate of all-cause hospitalization and stay.

Results 280 patients (73% male, aged 71 ± 14 years and 73% left ventricular systolic dysfunction) were initially randomized to home-based (n = 143) or clinic-based (n = 137) intervention. During extended follow-up (complete for 274 patients), 1139 all-cause hospitalizations (7477 days of hospital stay) and 121 (43.2%) deaths occurred. There was no difference in the primary endpoint; 20 (14.0%) home-based versus 13 (7.4%) clinic-based patients remained event-free (adjusted HR 0.89, 95% CI 0.70 to 1.15; p = 0.378). Significantly fewer home-based (51/143, 35.7%) than clinic-based intervention (71/137, 51.8%) patients died (adjusted HR 0.62, 95% CI 0.42 to 0.90: p = 0.012). Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations (p = 0.087) associated with 3067 (median 4.0, IQR 2.0 to 6.8) versus 4410 (6.0, IQR 3.0 to 12.0) days of hospital stay (p < 0.01 for rate and duration of hospital stay).

Conclusions Relative to clinic-based intervention, home-based intervention was not associated with prolonged event-free survival. Home-based intervention was, however, associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term.

Trial registration
Australian New Zealand Clinical Trials Registry number 12607000069459 (http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81803)
Keyword Chronic heart failure
Disease management programs
Readmission
Survival
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 22 April 2014

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2015 Collection
School of Nursing, Midwifery and Social Work Publications
 
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Citation counts: TR Web of Science Citation Count  Cited 15 times in Thomson Reuters Web of Science Article | Citations
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Created: Mon, 12 May 2014, 21:05:26 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work