Improved cost-effectiveness for management of chronic heart failure by combined home-based intervention with clinical nursing specialists

Background/Purpose: The influence of home- and clinic-based caring system on the economic burden of heart failure remains unknown. Methods: Between January 2004 and December 2004, chronic heart failure patients who were followed up by specialist nurse-led telephone visiting regularly were enrolled. Clinical and economic data half a year before enrollment were collected as control. Results: A total of 247 patients (168 males, 79 females; mean age, 60 17 years) were enrolled. The mean follow-up period was 139 96 days. The mean left ventricular ejection fraction was 35%. There were 1618 times of specialist nurse-led telephone visiting (average 8 +/- 6 times/patient). The mortality rate was 5.7%. Before enrollment, the total hospitalization fees were US$624,020. After enrollment, the cost was reduced to US$362,722 (41.8% reduction). The mean functional class (New York Heart Association) also improved from 2.27 +/- 0.80 to 1.96 +/- 0.90 (p < 0.001). The mean duration of hospital stay due to heart failure was reduced by 5.3 days (26.2% decrement). The total numbers of admission were reduced to 36 times (33.0% decrement). The readmission rate due to etiologies other than heart failure (such as infection, gastrointestinal bleeding, etc.) was reduced from 15.9% to 7.7%. The total fees of visiting emergency station were reduced from US$6528 to US$6101 (6.5% decrement). On the other hand, the frequency of visiting the outpatient department (OPD) increased from 5.2 +/- 3.2 to 6.6 +/- 4.1 tines/patient (p < 0.001). The total fees of visiting OPD increased from US$90,783 to US$94,855 (4.4% increment). Conclusion: The home- and clinic-based caring system is capable of decreasing adverse outcomes, most notably hospitalization and length of stay, and could trigger significant cost savings in the management of heart failure.