Worsening chronic heart failure and the link to frequent hospital admissions and need of specialist care (original) (raw)
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European Journal of Heart Failure, 2008
Background: Worsening chronic heart failure (CHF) is largely characterized by frequent hospital admissions and the need for specialist care. Aim: To evaluate the feasibility of home care (HC) versus conventional care (CC) in relation to health-related quality of life (HRQL) and cost-utility in patients with worsening CHF. Methods: Thirty-one patients seeking medical attention at hospital for worsening CHF were randomised to HC or CC. Following discharge within 48 hours from the hospital, patients in the HC group were followed-up in their homes by a specialist nurse. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Results: There was no significant difference in clinical events, adverse events or in HRQL. The total cost related to CHF was lower in the HC group after 12 months (p = 0.05). Conclusion: Reduction in cost of care for selected patients with CHF eligible for hospital care might be achieved by early discharge from hospital followed by home visits. Due to the small number of patients, these results must be interpreted with caution.
2009
Aim: To investigate gender-specifi c trends in long-term mortality in patients hospitalised for ischaemic and non-ischaemic heart failure (HF) and explore temporal trends in the risk of HF complicating acute myocardial infarction (AMI). Another aim is to characterise patients with chronic heart failure (CHF) that seek an emergency department (ED) because of their deteriorating condition and evaluate the feasibility of home care (HC) in comparison with conventional care (CC) in patients with worsening CHF. Patients and methods: In Papers I and II, data from the national hospital discharge and causespecifi c death registers were linked through the personal identity number. The hospital discharge register has been in operation since the 1960s and has operated on a nationwide basis since 1987. Between April 2004 and May 2006, patients seeking care for dyspnoea were identifi ed at the ED
2007
The aims of this thesis are to (1) explore the factors related to seeking care (Paper I), (2) describe the association between fatigue and selected symptoms (Paper II), (3) validate a method to detect the symptoms (Paper III) and (4) evaluate home care with respect to health-related quality of life (HRQL), medical safety, and cost-effectiveness in patients with worsening chronic heart failure (CHF) (Paper IV). All studies utilise data on patients with worsened CHF who sought care at the emergency department or heart failure clinic. Semi-structured interviews were performed (Paper I), and the questionnaires were administered in the form of interviews (Papers II – IV). Eligible patients (Paper IV) were randomised either to home care (HC) or conventional care (CC). Patients in the home care group were initially treated in the emergency department or in the ward and thereafter sent home. Follow-up took place the next day by a specialist nurse and thereafter every day or every other day ...
Care in the Home for the Management of Chronic Heart Failure
Journal of Cardiovascular Nursing, 2015
Background: The objective of this study was to determine the effect of care in the home (CHM) compared with usual care (UC) in patients with chronic heart failure (CHF) on clinical outcomes and healthcare use including a cost-effectiveness analysis. Methods: A systematic literature search on MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, as well as Centre for Reviews and Dissemination was conducted to identify randomized controlled trials comparing CHM with UC in CHF. The randomized controlled trials meeting inclusion criteria were meta-analyzed by outcome, and the quality of evidence for each outcome was evaluated using Grading of Recommendations Assessment, Development, and Evaluation system. A cost-effectiveness model was developed to estimate costs and quality-adjusted life years. Results: Six randomized controlled trials were identified from 1277 citations. Care in the home was predominately provided by a single health professional consisting of nurse-led education of varying duration and frequency. One study included pharmacist-led CHM. Care in the home showed a decreased risk for all-cause mortality and hospitalizations combined (risk ratio, 0.88; 95% confidence interval [CI], 0.80Y0.97), but not all-cause mortality alone (risk ratio, 0.92; 95% CI, 0.81Y1.04). Care in the home resulted in fewer hospitalizations (mean difference, j1.03; 95% CI, j1.53 to j0.53) and fewer emergency department visits (mean difference, j1.32; 95% CI, j1.87 to j0.77). Quality of life also improved with CHM delivered by nurses. Critical appraisal of the quality of evidence suggests uncertainty in the estimates for a number of outcomes. Care in the home resulted in a savings of $10,665 and a gain of 0.11 quality-adjusted life years compared with UC. Conclusions: In conclusion, the beneficial effect of CHM in CHF is by reducing mortality and hospitalizations combined. Care in the home in CHF seems to be more effective and less costly compared with UC.
Circulation, 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 (nϭ149) or usual postdischarge care (UC) (nϭ148) 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; PϽ0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; PϽ0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; PϽ0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04Ϯ3.23 versus 3.66Ϯ7.62 admissions; PϽ0.05) and related hospital stay (14.8Ϯ23.0 versus 28.4Ϯ53.4 days per patient per year; PϽ0.05) 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
European Journal of Heart Failure, 2009
The 'Hospital at home' (HaH) model avoids hospital admission by transferring healthcare and treatment to the patient's home. We aimed to compare the effectiveness and direct healthcare costs of treating elderly patients with decompensated heart failure (HF) using HaH care vs. inpatient hospital care (IHC) in a cardiology unit. Methods and results Eighty patients aged over 65 years who presented at the emergency department with decompensated HF were randomly assigned to IHC or HaH. All patients were studied for 1 year. Seventy-one patients completed the study, of these 34 were admitted to cardiology and 37 received HaH care. No significant differences were found in baseline characteristics, including comorbidity, functional status, and health-related quality of life. Clinical outcomes were similar after initial admission and also after the 12 months of follow-up. Death or re-admission due to HF or another cardiovascular event occurred in 19 patients in IHC and 20 in HaH (P ¼ 0.88). Changes in functional status and health-related quality of life over the follow-up period were not significantly different. The average cost of the initial admission was 4502 + 2153E in IHC and 2541 + 1334E in HaH (P , 0.001). During 12 months of follow-up, the average expenditure was 4619 + 7679E and 3425 + 4948E (P ¼ 0.83) respectively. Conclusion Hospital at home care allows an important reduction in the costs during the index episode compared with hospital care, whilst maintaining similar outcomes with respect to cardiovascular mortality and morbidity and quality of life at 1 year follow-up.
International Journal of Cardiology, 2016
Introduction: Since reported evidence is both scarce and controversial, the objective of this study is to determine the risk factors involved in the prognosis of older patients with heart failure (HF) receiving home healthcare from primary care professionals. Methods: Retrospective cohort community study carried out in 52 primary healthcare centres in Barcelona (Spain). A follow-up was performed between January 2009 and December 2012 with 7461 HF patients aged >64 years. Information was obtained from
Can home care for homebound patients with chronic heart failure reduce hospitalizations and costs?
PLOS ONE, 2017
Background Congestive heart failure (CHF), a common problem in adults, is associated with multiple hospitalizations, high mortality rates and high costs. Purpose To evaluate whether home care for homebound patients with CHF reduces healthcare service utilization and overall costs. Methods A retrospective study of healthcare utilization among homebound patients who received home care for CHF from 2012-1015. The outcome measures were number of hospital admissions per month, total number of hospitalization days and days for CHF only, emergency room visits, and overall costs. A comparison was conducted between the 6-month period prior to entry into home care and the time in home care. Results Over the study period 196 patients were treated by home care for CHF with a mean age of 79.4±9.5 years. 113 (57.7%) were women. Compared to the six months prior to home care, there were statistically significant decreases in hospitalizations (46.3%), in the number of total in-hospital days (28.7%), in the number of in-hospital days for CHF (66.7%), in emergency room visits (47%), and in overall costs (23.9%). Conclusion Home care for homebound adults with CHF can reduce healthcare utilization and healthcare costs.