Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort
dc.contributor.author | Stewart, S. | |
dc.contributor.author | Carrington, M. | |
dc.contributor.author | Horowitz, J. | |
dc.contributor.author | Marwick, T. | |
dc.contributor.author | Newton, P. | |
dc.contributor.author | Davidson, P. | |
dc.contributor.author | Macdonald, P. | |
dc.contributor.author | Thompson, D. | |
dc.contributor.author | Chan, Y. | |
dc.contributor.author | Krum, H. | |
dc.contributor.author | Reid, Christopher | |
dc.contributor.author | Scuffham, P. | |
dc.date.accessioned | 2017-01-30T13:47:58Z | |
dc.date.available | 2017-01-30T13:47:58Z | |
dc.date.created | 2015-10-29T04:09:45Z | |
dc.date.issued | 2014 | |
dc.identifier.citation | Stewart, S. and Carrington, M. and Horowitz, J. and Marwick, T. and Newton, P. and Davidson, P. and Macdonald, P. et al. 2014. Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort. International Journal of Cardiology. 174 (3): pp. 600-610. | |
dc.identifier.uri | http://hdl.handle.net/20.500.11937/35141 | |
dc.identifier.doi | 10.1016/j.ijcard.2014.04.164 | |
dc.description.abstract |
Objectives We compared the longer-term impact of the two most commonly applied forms of post-discharge management designed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure (CHF). Methods We followed a multi-center randomized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 ± 216 days. Blinded endpoints included event-free survival from all-cause emergency hospitalization or death, all-cause mortality and rate of all-cause hospitalization and stay. Results 280 patients (73% male, aged 71 ± 14 years and 73% left ventricular systolic dysfunction) were initially randomized to home-based (n = 143) or clinic-based (n = 137) intervention. During extended follow-up (complete for 274 patients), 1139 all-cause hospitalizations (7477 days of hospital stay) and 121 (43.2%) deaths occurred. There was no difference in the primary endpoint; 20 (14.0%) home-based versus 13 (7.4%) clinic-based patients remained event-free (adjusted HR 0.89, 95% CI 0.70 to 1.15; p = 0.378). Significantly fewer home-based (51/143, 35.7%) than clinic-based intervention (71/137, 51.8%) patients died (adjusted HR 0.62, 95% CI 0.42 to 0.90: p = 0.012). Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations (p = 0.087) associated with 3067 (median 4.0, IQR 2.0 to 6.8) versus 4410 (6.0, IQR 3.0 to 12.0) days of hospital stay (p < 0.01 for rate and duration of hospital stay). Conclusions Relative to clinic-based intervention, home-based intervention was not associated with prolonged event-free survival. Home-based intervention was, however, associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term. | |
dc.publisher | Elsevier Ireland Ltd | |
dc.title | Prolonged impact of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort | |
dc.type | Journal Article | |
dcterms.source.volume | 174 | |
dcterms.source.number | 3 | |
dcterms.source.startPage | 600 | |
dcterms.source.endPage | 610 | |
dcterms.source.issn | 0167-5273 | |
dcterms.source.title | International Journal of Cardiology | |
curtin.department | Department of Health Policy and Management | |
curtin.accessStatus | Fulltext not available |
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