Show simple item record

dc.contributor.authorStewart, Simon
dc.contributor.authorCarrington, Melinda J
dc.contributor.authorMarwick, Thomas H
dc.contributor.authorDavidson, Patricia M
dc.contributor.authorMacdonald, Peter
dc.contributor.authorHorowitz, John D
dc.contributor.authorKrum, Henry
dc.contributor.authorNewton, Phillip J
dc.contributor.authorReid, Christopher
dc.contributor.authorChan, Yih Kai
dc.contributor.authorScuffham, Paul A
dc.date.accessioned2017-05-03T14:20:20Z
dc.date.available2017-05-03T14:20:20Z
dc.date.issued2012
dc.date.modified2013-06-17T02:57:06Z
dc.identifier.issn0735-1097
dc.identifier.doi10.1016/j.jacc.2012.06.025
dc.identifier.urihttp://hdl.handle.net/10072/47731
dc.description.abstractObjectives 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.
dc.description.peerreviewedYes
dc.description.publicationstatusYes
dc.languageEnglish
dc.language.isoeng
dc.publisherElsevier
dc.publisher.placeUnited States
dc.relation.ispartofstudentpublicationN
dc.relation.ispartofpagefrom1239
dc.relation.ispartofpageto1248
dc.relation.ispartofissue14
dc.relation.ispartofjournalJournal of the American College of Cardiology
dc.relation.ispartofvolume60
dc.rights.retentionY
dc.subject.fieldofresearchCardiovascular medicine and haematology
dc.subject.fieldofresearchcode3201
dc.titleImpact 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
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.date.issued2012
gro.hasfulltextNo Full Text
gro.griffith.authorScuffham, Paul A.


Files in this item

FilesSizeFormatView

There are no files associated with this item.

This item appears in the following Collection(s)

  • Journal articles
    Contains articles published by Griffith authors in scholarly journals.

Show simple item record