Simon Stewart1, Melinda J Carrington2, John D Horowitz3, Thomas H Marwick4, Phillip J Newton5, Patricia M Davidson6, Peter Macdonald7, David R Thompson8, Yih-Kai Chan2, Henry Krum9, Christopher Reid9, Paul A Scuffham10. 1. Preventative Cardiology and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. Electronic address: simon.stewart@bakeridi.edu.au. 2. Preventative Cardiology and NHMRC Centre of Research Excellence to Reduce Inequality in Heart Disease, Baker IDI Heart and Diabetes Institute, Melbourne, Australia. 3. The Queen Elizabeth Hospital and University of Adelaide, Adelaide, Australia. 4. Menzies Research Institute Tasmania, Hobart, Australia. 5. The Centre for Cardiovascular and Chronic Care, University of Technology Sydney, St Vincent's and Mater Health, Sydney, Australia. 6. Faculty of Health, University of Technology Sydney and St Vincent's Hospital, Sydney, Australia. 7. St Vincent's Hospital and Victor Chang Cardiac Research Institute, Sydney, Australia. 8. Cardiovascular Research Centre, Faculty of Health Science, Australian Catholic University, Melbourne, Australia. 9. Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health & Preventive Medicine, Monash University, Australia. 10. Centre for Applied Health Economics, School of Medicine, Griffith Health Institute, Griffith University, Brisbane, Australia.
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. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry number 12607000069459 (http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81803).
RCT Entities:
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. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry number 12607000069459 (http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=81803).
Authors: Simon Stewart; Barbara Riegel; Cynthia Boyd; Yasmin Ahamed; David R Thompson; Louise M Burrell; Melinda J Carrington; Andrew Coats; Bradi B Granger; Julie Hides; William S Weintraub; Debra K Moser; Victoria Vaughan Dickson; Cressida J McDermott; Ashley K Keates; Michael W Rich Journal: Int J Cardiol Date: 2016-03-10 Impact factor: 4.164
Authors: P A Scuffham; J Ball; J D Horowitz; C Wong; P J Newton; P Macdonald; J McVeigh; A Rischbieth; N Emanuele; M J Carrington; C M Reid; Y K Chan; S Stewart Journal: Eur Heart J Date: 2017-08-07 Impact factor: 29.983
Authors: Thomas T H Wan; Amanda Terry; Enesha Cobb; Bobbie McKee; Rebecca Tregerman; Sara D S Barbaro Journal: Health Serv Res Manag Epidemiol Date: 2017-04-18
Authors: Ruth Ann Marrie; Aaron Miller; Maria Pia Sormani; Alan Thompson; Emmanuelle Waubant; Maria Trojano; Paul O'Connor; Stephen Reingold; Jeffrey A Cohen Journal: Neurology Date: 2016-02-17 Impact factor: 9.910