Impact of Nurse-Led, Multidisciplinary Home-Based Intervention on Event-Free Survival Across the Spectrum of Chronic Heart Disease: Composite Analysis of Health Outcomes in 1226 Patients From 3 Randomized Trials
Background—We sought to determine the overall impact of a nurse-led, multidisciplinary home-based intervention (HBI) adapted to hospitalized patients with chronic forms of heart disease of varying types.
Methods and Results—Prospectively planned, combined, secondary analysis of three randomized trials (1226 patients) of HBI compared to standard management. Hospitalized patients presenting with heart disease but not heart failure (HF), atrial fibrillation (AF) but not HF, as well as HF were recruited. Overall, 612 and 614 patients, respectively, were allocated to a home visit 7 to 14-days post-discharge by a cardiac nurse with follow-up and multidisciplinary support according to clinical need or standard management. The primary outcome of days-alive and out-of-hospital was examined on an intention-to-treat basis. During 1371-days (IQR 1112-1605) follow-up, 218 patients died and 17917-days of hospital stay were recorded. Compared to standard management, HBI patients achieved significantly prolonged event-free survival (90.1% [95% CI 88.2-92.0] versus 87.2% [95% CI 85.1-89.3] days-alive and out-of-hospital; p=0.020). This reflected less all-cause mortality (adjusted hazard ratio 0.67, 95% CI 0.50-0.88; p=0.005) and unplanned hospital stay (median 0.22 [IQR 0-1.3] versus 0.36 [0-2.1] days/100-days follow-up; p=0.011). Analyses of the differential impact of HBI on all-cause mortality showed significant interactions (characterized by U-shaped relationships) with age (p=0.005) and comorbidity (p=0.041); HBI being most effective for those aged 60-82 years (59%-65% of individual trial cohorts) and 5-8 concurrent diagnoses (36%-61%).
Conclusions—These data provide further support for the application of post-discharge HBI across the full spectrum of patients being hospitalized for chronic forms of heart disease.
Clinical Trial Registration Information—www.anzctr.org.au. Identifiers: 12610000221055, 12608000022369, 12607000069459.
- multidisciplinary management
- heart disease
- secondary prevention
- health outcomes
- hospital readmission follow-up studies
- Received January 28, 2016.
- Revision received March 6, 2016.
- Accepted March 11, 2016.
Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.