© 2005 European Society of Cardiology
Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure
a Chinese University of Hong Kong Hong Kong
b City Hospitals Sunderland/University of Northumbria United Kingdom
c School of Nursing and Midwifery, Centenary Building, City East Campus, University of South Australia North Terrace, 5000, South Australia, Australia
* Corresponding author. Tel.: +61 8 8302 1115; fax: +61 8 8302 1806. E-mail address: simon.stewart{at}unisa.edu.au
 |
Abstract |
|---|
Background: Few studies have examined the potential benefits of specialist nurse-led programs of care involving home and clinic-based follow-up to optimise the post-discharge management of chronic heart failure (CHF).
Objective: To determine the effectiveness of a hybrid program of clinic plus home-based intervention (C+HBI) in reducing recurrent hospitalisation in CHF patients.
Methods: CHF patients with evidence of left ventricular systolic dysfunction admitted to two hospitals in Northern England were assigned to a C+HBI lasting 6 months post-discharge (n=58) or to usual, post-discharge care (UC: n=48) via a cluster randomization protocol. The co-primary endpoints were death or unplanned readmission (event-free survival) and rate of recurrent, all-cause readmission within 6 months of hospital discharge.
Results: During study follow-up, more UC patients had an unplanned readmission for any cause (44% vs. 22%: P=0.019, OR 1.95 95% CI 1.10–3.48) whilst 7 (15%) versus 5 (9%) UC and C+HBI patients, respectively, died (P=NS). Overall, 15 (26%) C+HBI versus 21 (44%) UC patients experienced a primary endpoint. C+HBI was associated with a non-significant, 45% reduction in the risk of death or readmission when adjusting for potential confounders (RR 0.55, 95% CI 0.28–1.08: P=0.08). Overall, C+HBI patients accumulated significantly fewer unplanned readmissions (15 vs. 45: P<0.01) and days of recurrent hospital stay (108 vs. 459 days: P<0.01). C+HBI was also associated with greater uptake of beta-blocker therapy (56% vs. 18%: P<0.001) and adherence to Na restrictions (P<0.05) during 6-month follow-up.
Conclusion: This is the first randomised study to specifically examine the impact of a hybrid, C+HBI program of care on hospital utilisation in patients with CHF. Its beneficial effects on recurrent readmission and event-free survival are consistent with those applying either a home or clinic-based approach.
Key Words: Chronic heart failure • Randomised trial • Home-based intervention • Outpatient clinic • Morbidity
Received April 7, 2004; Revised June 1, 2004; Accepted October 14, 2004
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  V. Tibaldi, G. Isaia, C. Scarafiotti, F. Gariglio, M. Zanocchi, M. Bo, S. Bergerone, and N. A. Ricauda Hospital at Home for Elderly Patients With Acute Decompensation of Chronic Heart Failure: A Prospective Randomized Controlled Trial Arch Intern Med, September 28, 2009; 169(17): 1569 - 1575. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. E. Roughead, J. D. Barratt, E. Ramsay, N. Pratt, P. Ryan, R. Peck, G. Killer, and A. L. Gilbert The Effectiveness of Collaborative Medicine Reviews in Delaying Time to Next Hospitalization for Patients With Heart Failure in the Practice Setting: Results of a Cohort Study Circ Heart Fail, September 1, 2009; 2(5): 424 - 428. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hallerbach, A. Francoeur, S. C. Pomerantz, C. Oliner, D. L. Morris, G. Eiger, J. Cohn, and M. Goldfinger Patterns and Predictors of Early Hospital Readmission in Patients With Congestive Heart Failure American Journal of Medical Quality, February 1, 2008; 23(1): 18 - 23. [Abstract] [PDF]
|
|