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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
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, Volume 174, No. 3, Year 2014
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Description
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) © 2013 Elsevier Ireland Ltd.
Authors & Co-Authors
Stewart, Simon D.
Australia, Parkes
Australian Government
Carrington, Melinda J.
Australia, Parkes
Australian Government
Horowitz, John D.
Australia, Woodville South
The Queen Elizabeth Hospital, North Western Adelaide Health Service
Marwick, Thomas H.
Australia, Hobart
Menzies Institute for Medical Research
Davidson, Patricia Mary
Australia, Sydney
St. Vincent's Hospital Sydney
Macdonald, Peter Simon
Australia, Sydney
Victor Chang Cardiac Research Institute
Thompson, David R.
Australia, Sydney
Australian Catholic University
Chan, Yih Kai
Australia, Parkes
Australian Government
Krum, Henry
Australia, Clayton
Monash University
Reid, Christopher M.
Australia, Clayton
Monash University
Scuffham, P. Anthony
Australia, Brisbane
Griffith Health
Statistics
Citations: 35
Authors: 11
Affiliations: 9
Identifiers
Doi:
10.1016/j.ijcard.2014.04.164
ISSN:
01675273
Research Areas
Health System And Policy
Study Design
Randomised Control Trial
Cohort Study
Study Approach
Quantitative
Participants Gender
Male