Does a single home-based intervention reduce unplanned readmissions and out-of-hospital deaths in high-risk patients with congestive heart failure?
A single post-discharge home-based intervention provides sustained reductions in unplanned readmissions, mortality, and healthcare costs over 18 months in high-risk heart failure patients.
BACKGROUND: A single home-based intervention (HBI) applied immediately after hospital discharge in a cohort of "high-risk" patients with congestive heart failure has been shown to decrease numbers of unplanned readmissions plus out-of-hospital deaths during a period of 6 months. The duration of this beneficial effect remains uncertain. METHODS: Hospitalized patients with congestive heart failure who had been randomly assigned to receive either usual care (n=48) or HBI 1 week after discharge (n=49) were subject to an extended follow-up of 18 months. The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths. Secondary end points included total hospital stay, frequency of multiple readmissions, cost of hospital-based care, and total mortality. RESULTS: During 18-month follow-up, HBI patients had fewer unplanned readmissions (64 vs 125; P=. 02) and out-of-hospital deaths (2 vs 9; P=. 02), representing 1. 4+/-1. 3 vs 2. 7+/-2. 8 events per HBI and usual-care patient, respectively (P=. 03). The HBI patients also had fewer days of hospitalization (2. 5+/-2. 7 vs 4. 5+/-4. 8 per patient; P=. 004) and, once readmitted, were less likely to experience 4 or more readmissions (3/31 vs 12/38; P=. 03). Hospital-based costs were significantly lower among HBI patients (Aust 5100 vs Aust 10600 per patient; P=. 02). Unplanned readmission was positively correlated with 14 days or more of unplanned readmission in the 6 months before study entry (odds ratio OR, 5. 4; P=. 006). Positive correlates of death were (1) non-English speaking (OR, 4. 9; P=. 008), (2) 14 days or more of unplanned readmission in the 6 months before study entry (OR, 4. 9; P=. 008), and (3) left ventricular ejection fraction of 40% or less (OR, 3. 0; P=. 03) ; conversely, assignment to HBI was a negative correlate (OR, 0. 3; P=. 02). CONCLUSIONS: In this controlled study, among a cohort of high-risk patients with congestive heart failure, beneficial effects of a postdischarge HBI were sustained for at least 18 months, with a significant reduction in unplanned readmissions, total hospital stay, hospital-based costs, and mortality.
Stewart et al. (1999) studied this question.