Key result
Outpatient management of acute heart failure significantly increased the median number of days alive and out of hospital within 30 days compared to inpatient management (30 vs 17 days, p=0.018).
Why the study?
Acute heart failure hospitalisation is associated with 10% mortality, and outpatient-based management appeared effective in observational studies.
Does outpatient based management improve days alive and out-of-hospital or reduce mortality compared to standard inpatient care in patients with acute heart failure requiring IV diuretics?
RCT (n=24)
Open-label
Mixed block randomisation
No
Does outpatient based management improve days alive and out-of-hospital or reduce mortality compared to standard inpatient care in patients with acute heart failure requiring IV diuretics?
Answers are grounded in this paper and cite their sources.
Outpatient management of acute heart failure requiring IV diuretics appears feasible, yields significant cost savings, and improves mental well-being, though larger trials are needed to confirm clinical efficacy.
Objectives Acute heart failure (AHF) hospitalisation is associated with 10% mortality. Outpatient based management (OPM) of AHF appeared effective in observational studies. We conducted a pilot randomised controlled trial (RCT) comparing OPM with standard inpatient care (IPM).Methods We randomised patients with AHF, considered to need IV diuretic treatment for ≥2 days, to IPM or OPM. We recorded all-cause mortality, and the number of days alive and out-of-hospital (DAOH). Quality of life, mental well-being and Hope scores were assessed. Mean NHS cost savings and 95% central range (CR) were calculated from bootstrap analysis. Follow-up: 60 days.Results Eleven patients were randomised to IPM and 13 to OPM. There was no statistically significant difference in all-cause mortality during the index episode (1/11 vs 0/13) and up to 60 days follow-up (2/11 vs 2/13) [p = .86]. The OPM group accrued more DAOH {47 [36,51] vs 59 [41,60], p = .13}. Two patients randomised to IPM (vs 6 OPM) were readmitted [p = .31]. Hope scores increased more with OPM within 30 days but dropped to lower levels than IPM by 60 days. More out-patients had increased total well-being scores by 60 days (p = .04). OPM was associated with mean cost savings of £2658 (95% CR 460–4857) per patient.Conclusions Patients with acute HF randomised to OPM accrued more days alive out of hospital (albeit not statistically significantly in this small pilot study). OPM is favoured by patients and carers and is associated with improved mental well-being and cost savings.
No takes yet. Share an insight, caveat, or question.
Wong et al. (2023) conducted an RCT in Acute heart failure (n=24). Out-patient based management (OPM) vs. Inpatient management (IPM) was evaluated on Number of full days alive and out of hospital (DAOH) within 30 days (p=0.018). Outpatient management of acute heart failure significantly increased the median number of days alive and out of hospital within 30 days compared to inpatient management (30 vs 17 days, p=0.018).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: