Home-Based Intervention in Congestive Heart Failure

BACKGROUND: It is not known to what extent initially observed benefits of postdischarge programs of care for patients with chronic congestive heart failure (CHF) in respect to event-free survival, readmissions, and healthcare costs persist in the long term. Methods and Results- We prospectively studied the long-term effects of a multidisciplinary home-based intervention (HBI) in a cohort of CHF patients randomly allocated to either to HBI (n=149) or usual care (n=148). During a median of 4. 2 years of follow-up, there were significantly fewer primary end points (unplanned readmission or death) in the HBI versus usual care group: a mean of 0. 21 versus 0. 37 primary events per patient per month (P<0. 01). Median event-free survival was more prolonged in the HBI than usual care group (7 versus 3 months; P<0. 01). Fewer HBI patients died (56% versus 65%; P=0. 06) and had more prolonged survival (a median of 40 versus 22 months; P<0. 05) compared with usual care. Assignment to HBI was both an independent predictor of event-free survival (RR 0. 70; P<0. 01) and survival alone (RR 0. 72; P<0. 05). Overall, HBI patients had 78 fewer unplanned readmissions compared with usual care (0. 17 versus 0. 29 readmissions per patient per month; P<0. 05). The median cost of these readmissions was A325 versus A660/month per HBI and usual care patient (P<0. 01). CONCLUSIONS: The beneficial effects of HBI in reducing frequency of unplanned readmissions in CHF patients persist in the long term and are associated with prolongation of survival.