Heart failure care in a hospital unit: a comparison of standard 3-month and extended 6-month programs

Background: We have previously shown that a structured in-hospital and outpatient heart failure (HF) program reduces clinical events over a 3-month period following hospital discharge. Aims: This prospective randomized controlled study examines the additional benefits of extending the standard 3-month HF program to 6 months on death and readmission over a 2-year follow-up period. Methods: Of 161 patients admitted with NYHA class IV HF who completed the standard 3-month HF program, 130 consenting patients (mean age 69.9 +/- 12.2 years, 65% male) were randomized to the extended 6-month HF program (EP; n=62) or standard care (SP; n=68). The primary endpoint was death and/or unplanned rehospitalization for HF at 2 years postrandomization. Results: In the 2-year follow-up period, there were eight people with unplanned hospitalizations for HF and 16 deaths in the EP group (event rate 38.7%) compared to seven people with unplanned HF readmissions and 14 deaths in the SP group (event rate 30.9%, p=0.348 versus EP). Kaplan-Meier survival analysis demonstrated no difference in outcome between standard and extended program (p=0.315). There were no differences between the groups in terms of unscheduled clinic visits or non-HF-related readmissions in the 2-year follow-up period. Conclusions: There is no measured clinical advantage in terms of death and/or HF readmission in extending a structured hospital-based disease management program for HF beyond 3 months postdischarge. However, it appears that patients continue to need access to the service to help abort clinical deteriorations, and this may have implication for the optimal organisation of such programs. (C) 2004 European Society of Cardiology. Published by Elsevier B.V.