Prolonged beneficial effects of a home-based intervention on unplanned readmissions and mortality among patients with congestive heart failure

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 $10 600 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.