Impact of Home Versus Clinic-Based Management of Chronic Heart Failure: The WHICH? (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care) Multicenter, Randomized Trial

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Title Impact of Home Versus Clinic-Based Management of Chronic Heart Failure: The WHICH? (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care) Multicenter, Randomized Trial
Author Stewart, Simon; Carrington, Melinda J.; Marwick, Thomas H.; Davidson, Patricia M.; Macdonald, Peter; Horowitz, John D.; Krum, Henry; Newton, Phillip J.; Reid, Christopher; Chan, Yih Kai; Scuffham, Paul Anthony
Journal Name Journal of the American College of Cardiology
Year Published 2012
Place of publication United States
Publisher Elsevier
Abstract Objectives The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure (CHF) management. Background Although direct patient contact appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear. Methods This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71 14 years, and 73% with left ventricular ejection fraction 45%) randomized to home-based intervention (HBI) or specialized CHF clinic–based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs. Results The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio [HR]: 0.97 [95% confidence interval (CI): 0.73 to 1.30], p 0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p 0.887), and 31 (21.7%) versus 38 (27.7%) died (p 0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 [interquartile range (IQR): 2.0 to 7.0] days vs. 6.0 [IQR: 3.5 to 13] days; p 0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 [95% CI: 1.37 to 4.73], p 0.003). HBI was associated with significantly fewer days of all-cause hospitalization (35%; p 0.003) and from cardiovascular causes (37%; p 0.025) but not for CHF (24%; p 0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 [IQR: 13 to 81] per day vs. $AU52 [17 to 140] per day; p 0.030). Conclusions HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was associated with significantly lower healthcare costs, attributable to fewer days of hospitalization.
Peer Reviewed Yes
Published Yes
Alternative URI http://dx.doi.org/10.1016/j.jacc.2012.06.025
Volume 60
Issue Number 14
Page from 1239
Page to 1248
ISSN 0735-1097
Date Accessioned 2012-10-15
Date Available 2013-06-17T02:57:06Z
Language en_US
Research Centre Griffith Health Institute; Population and Social Health Research Program
Faculty Griffith Health Faculty
Subject Medical and Health Sciences
URI http://hdl.handle.net/10072/47731
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1

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