The WHICH? Trial: Rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients
MetadataShow full item record
Aims: To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. Methods: WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patient’s own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 1218 months of follow-up. Of 688 eligible patients, 280 patients (73 male and 66 principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n 143) or clinic-based (n 137) post-discharge management. This will provide 80 power (two-sided alpha of 0.05) to detect a 15 absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63), coronary artery disease (55), and atrial fibrillation (53) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Perspective: Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients.
Showing items related by title, author, creator and subject.
An integrated approach to outcome evaluation : incorporating patient reported outcomes in heart failureChang, Sungwon (2012)Globally individuals and health care systems are facing the burden of chronic illness. The impact of the increasing burden of non-communicable diseases is experienced by individuals and health care systems. Across the ...
Clifford, Rhonda (2004)People with diabetes mellitus are more likely to die from cardiovascular causes than those without diabetes, and modifiable risk factors, such as hyperglycaemia, dyslipidaemia and hypertension can be targeted in intervention ...
McKnight, David (2011)Background: Medication Safety has become a major health issue in Australia and internationally. Medication use is a part of most people lives with around seven in ten Australians and nine in ten older Australians having ...