INTENSIVE HOME-CARE SURVEILLANCE PREVENTS HOSPITALIZATION AND IMPROVES MORBIDITY RATES AMONG ELDERLY PATIENTS WITH SEVERE CONGESTIVE-HEART-FAILURE

The purpose of this study was to examine the impact of intensive home- care surveillance on morbidity rates of elderly patients with severe c ongestive heart failure. Forty-two patients aged 78 +/- 8 years who ha d severe congestive heart failure (New York Heart Association function al classes III through IV, mean ejection fraction 27% +/- 6%), were ex amined at least once a week at home by internists from the district ho spital and by a trained paramedical team. The year before entry to the home-care program was compared to the first year of home surveillance . The mean total hospitalization (hosp) rate was reduced from 3.2 +/- 1.5 hosp/yr to 1.2 +/- 1.6 hosp/yr and duration from 26 +/- 14 days/yr to 6 +/- 7 days/yr (p < 0.001 for both). Cardiovascular admissions de creased from 2.9 +/- 1.5 hosp/yr to 0.8 +/- 1.1 hosp/yr and duration f rom 23 +/- 13 days/yr to 4 +/- 4 days/yr (p < 0.001). The vital status (ability to perform daily activities, expressed in a 1 to 4 scale) wa s improved from 1.4 +/- 0.9 to 2.3 +/- 0.7 (p < 0.001). In conclusion, an intensive home-care program was associated with a marked decrease in the need for hospitalization and improved the functional status of elderly patients with severe congestive heart failure. Such a service might also have a cost-effective advantage and a major impact on healt h expenditure.