Extending the horizon in chronic heart failure - Effects of multidisciplinary, home-based intervention relative to usual care

被引:90
作者
Inglis, Sally C.
Pearson, Sue
Treen, Suzette
Gallasch, Tamara
Horowitz, John D.
Stewart, Simon
机构
[1] Baker Heart Res Inst, Melbourne, Vic 3004, Australia
[2] Univ Queensland, Fac Hlth Sci, Brisbane, Qld, Australia
[3] Univ S Australia, Div Hlth Sci, Adelaide, SA 5001, Australia
[4] Univ Adelaide, Queen Elizabeth Hosp, Dept Cardiol, Woodville, SA 5011, Australia
关键词
cost-benefit analysis; heart failure; prevention; prognosis;
D O I
10.1161/CIRCULATIONAHA.106.638122
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown. Methods and Results-The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P < 0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P < 0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P < 0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04 +/- 3.23 versus 3.66 +/- 7.62 admissions; P < 0.05) and related hospital stay (14.8 +/- 23.0 versus 28.4 +/- 53.4 days per patient per year; P < 0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1729 per additional life-year gained when we accounted for healthcare costs including the HBI. Conclusions-In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.
引用
收藏
页码:2466 / 2473
页数:8
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