Published Online
on November 20, 2006

A more recent version of this article appeared on December 5, 2006

This Article Full Text (PDF) CME: Take the course for this article: Circulation: December 5, 2006, Volume 114, Number 23 All Versions of this Article: 114/23/2466    most recent CIRCULATIONAHA.106.638122v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Inglis, S. C. Articles by Stewart, S. Search for Related Content PubMed PubMed Citation Articles by Inglis, S. C. Articles by Stewart, S. Related Collections Congestive Compliance/Adherence Secondary prevention Related Article

Submitted on May 3, 2006
Revised on September 20, 2006
Accepted on September 25, 2006

Extending the Horizon in Chronic Heart Failure. Effects of Multidisciplinary, Home-Based Intervention Relative to Usual Care

Sally C. Inglis BHSc(Hons), Sue Pearson PhD, Suzette Treen BHSc, Tamara Gallasch BBSc, John D. Horowitz PhD, and Simon Stewart PhD^*

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.

^* To whom correspondence should be addressed. E-mail: simon.stewart{at}baker.edu.au.

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.

Key words: cost-benefit analysis • heart failure • prevention • prognosis

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