EFFECTS OF A HOME-BASED INTERVENTION AMONG PATIENTS WITH CONGESTIVE-HEART-FAILURE DISCHARGED FROM ACUTE HOSPITAL-CARE

Background: We examined the effect of a home-based intervention (HBI) on readmission and death among ''high-risk'' patients with congestive heart failure discharged home from acute hospital care. Methods: Hospi talized patients with congestive heart failure and impaired systolic f unction, intolerance to exercise, and a history of 1 or more hospital admissions for acute heart failure were randomized to either usual car e (n=48) or HBI at 1 week after discharge (n=49). Home-based intervent ion comprised a single home visit (by a nurse and pharmacist) to optim ize medication management, identify early clinical deterioration, and intensify medical follow-up and caregiver vigilance as appropriate. Th e primary end point of the study was frequency of unplanned readmissio ns plus out-of-hospital deaths within 6 months of discharge. Secondary end points included duration of hospital stay and overall mortality. Results: During, follow-up, patients in the HBI group had fewer unplan ned readmissions (36 vs 63; P=.03) and fewer out-of-hospital deaths (1 vs 5; P=.11): 0.8+/-0.9 vs 1.4+/-1.8 (mean +/- SD) events per patient assigned to HBI and usual care, respectively (P=.03). Patients in the HBI group also had fewer days of hospitalization (261 vs 452; P=.05) and fewer total deaths (6 vs 12; P=.ll). Patients assigned to usual ca re were more likely to experience 3 or more readmissions for acute hea rt failure (P=.02). Predictors of unplanned readmission were (1) 14 da ys or more of unplanned readmission during the 6 months before study e ntry (odds ratio [OR], 5.2; 95% confidence interval [CI], 1.8-16.2), ( 2) previous admission for acute myocardial ischemia (OR, 3.3; 95% Cl, 1.2-9.1), and (3) an albumin plasma concentration of 38 g/L or less (O R, 2.4; 95% CI, 1.2-6.0). Home-based intervention was also associated with a trend toward reduced risk of unplanned readmission (OR, 0.4; 95 % CI, 0.2-1.1). Conclusion: Among a cohort of high-risk patients with congestive heart failure, HBI was associated with reduced frequency of unplanned readmissions plus out-of-hospital deaths within 6 months of discharge from the hospital.