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BackgroundWorsening chronic heart failure (CHF) is largely characterised by disabling symptoms, poor quality of life, frequent hospital admissions and need of specialist care. Lack of alternative care results in involuntary hospitalisation.AimIn a pilot study evaluate home care (HC) versus conventional care (CC) in relation to medical safety, health-related quality of life (HRQL) and cost-utility in patients with worsening CHF.MethodThirty-one patients with deteriorating CHF were randomised to HC or CC when seeking medical attention at hospital. Patients in the HC group were discharged from the hospital and were followed-up in their homes by a specialist nurse. Patients in the control group were treated in hospital with usual care. Follow-ups were conducted for both groups, 1, 4, 8 and 12 months after inclusion in the study. Health-related quality of life assessed by EuroQol-5D VAS, Standard Gamble technique, SF-36 and Kansas City cardiomyopathy Questionnaire. All health care related costs were assessed and cost utility analysis was performed to compare cost/QALYs between groups.ResultsThere was no significant difference in clinical events, adverse events or in HRQL. The total cost related to CHF was lower in the HC group after 12 months. Median direct health care related costs in HC were € 1122 and in CC € 5670 (p 0.05). Cost/QALYs ranged € 74–580 in HC compared to CC € 289–1013, calculated from each follow-up. The cost utility ratio was (CC/HC) 2.55 (SG) and 2.65 (VAS).ConclusionReductions in cost of care for selected patients with CHF eligible for hospital care might be achieved by a very early discharge from hospital followed by home visits. More importantly, HC seems to be safe and no difference was found in HRQL between two groups. This pilot study provides clinicians with useful information in their decisions concerning CHF patient management, who are reluctant to hospitalisation.

Objectives: Investigate trends in incidence and prognosis of myocarditis in Sweden during 2000-2014.Background: Myocarditis is an inflammatory heart disease, with scarce data concerning incidence and prognosis.Methods: Linking Swedish National Patient and Cause of Death Register, we identified individuals ≥16 years with first-time diagnosis of myocarditis during 2000-2014. Reference population, matched for age and birth year (n=16 622) was selected from the Swedish Total Population Register. Results: Among the 8 679 cases, (75% men, 64% <50 years), incidence rate/100 000 inhabitants rose from 6.3 to 8.6, mostly in men and those <50 years. Incident heart failure/dilated cardiomyopathy occurred in 6.2% within 1 year after index hospitalization and in 10.2% during 2000-2014, predominantly in those ≥50 years (12.1% within 1 year, 20.8% during 2000-2014). In all, 8.1% died within 1 year, 0.9% (<50 years) and 20.8% (≥50 years). Hazard ratios (adjusted for age, sex) for 1-year mortality comparing cases and controls were 4.00 (95% confidence interval 1.37-11.70), 4.48 (2.57-7.82), 4.57 (3.31-6.31) and 3.93 (3.39-4.57) for individuals aged <30, 30-<50, 50-<70, and ≥70 years, respectively. Conclusion: The incidence of myocarditis during 2000-2014 increased, predominantly in younger men. One-year mortality in the young was low, but fourfold higher compared with reference population.