Abstract 12157: Impact of a Hybrid Nurse-Led Home and Clinic-based Intervention on Hospitalization and Related Hospital Stay: Results From a Pragmatic, Randomized Trial (the NIL-CHF Study)
Background: Beyond pharmacological treatment, there is a paucity of data to support the application of disease management programs that bridge (predominantly short-term) cardiac rehabilitation and chronic heart failure (CHF) management programs.
Methods: The NIL-CHF Study was a pragmatic randomized trial that tested the hypothesis that relative to Standard Care a nurse-led, multidisciplinary management program for hospitalized patients aged ≥ 45 years with pre-existing CVD and/or common antecedents of CHF, will reduce the incidence of admission for CHF or all-cause mortality (primary endpoint) and secondary endpoints of rehospitalization and recurrent hospital stay (specific focus on emergency and cardiovascular-related events) during mean 4.3 years follow-up.
Results: A total of 611 subjects (mean age 66±11 years and 71% male) without baseline CHF (echocardiography confirmation), of whom 70% had an acute coronary syndrome and 62% were hypertensive, were randomized to Standard Care (n=310) or NIL-CHF intervention (n=301). Despite minimal difference in the primary endpoint (13.6% vs. 12.3% - adjusted HR 1.08, 95% CI 0.68, 1.72; p=0.756 for NIL-CHF vs. Standard Care groups), there were favorable trends for the key endpoints relating to hospitalization and, most importantly, hospital stay (see figure below). Specifically there was a significant reduction in emergency hospitalizations (1097 days less; p=0.023) and adjudicated cardiovascular hospitalizations (478 days less; p=0.052) in favour of the study intervention.
Conclusions: Whilst the NIL-CHF intervention did not significant reduce the incidence of CHF during 4.3 years follow-up, it did result in significantly reduced emergency and CV-related hospital stay; suggesting significant cost-benefits for high risk patients.
Author Disclosures: S. Stewart: None. C. Melinda: None. Y. Chan: None. G. Jennings: None. C. Wong: None.
- © 2014 by American Heart Association, Inc.