Published online before print November 20, 2006, doi: 10.1161/CIRCULATIONAHA.106.638122
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(Circulation. 2006;114:2466-2473.)
© 2006 American Heart Association, Inc.
Health Services and Outcomes Research |
Extending the Horizon in Chronic Heart Failure
Effects of Multidisciplinary, Home-Based Intervention Relative to Usual Care
From the University of Queensland, Faculty of Health Sciences, Brisbane, Queensland (S.C.I., S.S.); University of South Australia, Division of Health Sciences, Adelaide, South Australia (S.P., S.T., T.G.); Department of Cardiology, Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia (S.T., J.D.H.); and Baker Heart Research Institute, Melbourne (S.S.), Australia.
Correspondence to Simon Stewart, Preventative Cardiology, Baker Heart Research Institute, 75 Commercial Rd, Melbourne, Victoria, 3004, Australia. E-mail simon.stewart{at}baker.edu.au
Received May 3, 2006; revision received September 20, 2006; accepted September 25, 2006.
Background— The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown.
Methods and Results— The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04±3.23 versus 3.66±7.62 admissions; P<0.05) and related hospital stay (14.8±23.0 versus 28.4±53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional life-year gained when we accounted for healthcare costs including the HBI.
Conclusions— In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.
CLINICAL PERSPECTIVE
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