Effects of a nurse-led, clinic and home-based intervention on recurrent hospital use in chronic heart failure

Abstract

Background: Few studies have examined the potential benefits of specialist nurse-led programs of care involving home and clinic-based follow-up to optimise the post-discharge management of chronic heart failure (CHF). Objective: To determine the effectiveness of a hybrid program of clinic plus home-based intervention (C+HBI) in reducing recurrent hospitalisation in CHF patients. Methods: CHF patients with evidence of left ventricular systolic dysfunction admitted to two hospitals in Northern England were assigned to a C+HBI lasting 6 months post-discharge (n=58) or to usual, post-discharge care (UC: n=48) via a cluster randomization protocol. The coprimary endpoints were death or unplanned readmission (event-free survival) and rate of recurrent, all-cause readmission within 6 months of hospital discharge. Results: During study follow-up, more UC patients had an unplanned readmission for any cause (44% vs. 22%: P=0.019, OR 1.95 95% CI 1.10-3.48) whilst 7 (15%) versus 5 (9%) UC and C+HBI patients, respectively, died ( P=NS). Overall, 15 (26%) C+HBI versus 21 (44%) UC patients experienced a primary endpoint. C+HBI was associated with a non-significant, 45% reduction in the risk of death or readmission when adjusting for potential confounders (RR 0.55, 95% CI 0.28-1.08: P=0.08). Overall, C+HBI patients accumulated significantly fewer unplanned readmissions (15 vs. 45: Pb0.01) and days of recurrent hospital stay (108 vs. 459 days: Pb0.01). C+HBI was also associated with greater uptake of beta-blocker therapy (56% vs. 18%: Pb0.001) and adherence to Na restrictions ( Pb0.05) during 6-month follow-up. Conclusion: This is the first randomised study to specifically examine the impact of a hybrid, C+HBI program of care on hospital utilisation in patients with CHF. Its beneficial effects on recurrent readmission and event-free survival are consistent with those applying either a home or clinic-based approach.

The Effectiveness of Collaborative Medicine Reviews in Delaying Time to Next Hospitalization for Patients With Heart Failure in the Practice Setting

“…Similar programs offering home-based visits to patients with heart failure in collaboration with health professionals other than pharmacists, including nurse practitioners, have also been shown to be effective. 24,25 The white Paper on Pharmacy in England 26 identifies pharmacists as an underutilized resource in the health system, and the United Kingdom government is encouraging such role extension. 8 If the findings of this study are replicated in other patient groups who are at high risk of medication misadventure and consequent rehospitalization, there will be an even stronger case to require pharmacists to be involved in this extension of their role in collaboration with physicians.…”

Transitional Care for Patients With Congestive Heart Failure: A Systematic Review and Meta-Analysis

“…The meta-analysis showed a significant reduc- Reasons for exclusion: duplicates; editorials; letters; comments; reviews; protocols without data, without an intervention; not on transition, transition within hospitals, to nursing home, within specialist services; from emergency to the hospital; emergency conditions; education/health promotion; speci c intervention (eg, medication prescription only) 5 trials identied through the screening of reference lists 41 included in the systematic review * References 35,37,38,41,[44][45][46][47]50,54,55,57,60,67,68,73 T …”

Team-Based Care for Outpatients with Heart Failure

“…28 Later studies implementing team-based HF clinic interventions also reported improved functional status, quality of life, and HF medication optimization, and reduction in hospital readmissions, length of hospital stay, and health care costs. [29][30][31][32][33][34][35][36][37] Reduction in mortality and HF hospitalizations were further supported by subsequent meta-analyses evaluating HF clinic care in comparison with usual care. 28,[38][39][40] A systematic review of 29 randomized trials (5039 patients) incorporating multidisciplinary strategies for HF management reported reduced mortality, HF hospitalizations, and all-cause hospitalizations.…”