Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care.
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.
Hospitalized patients with congestive heart failure and impaired systolic function, intolerance to exercise, and a history of 1 or more hospital admissions for acute heart failure were randomized to either usual care (n=48) or HBI at 1 week after discharge (n=49).
Home-based intervention comprised a single home visit (by a nurse and pharmacist) to optimize medication management, identify early clinical deterioration, and intensify medical follow-up and care-giver vigilance as appropriate.
The primary end point of the study was frequency of unplanned readmissions plus out-of-hospital deaths within 6 months of discharge.
Secondary end points included duration of hospital stay and overall mortality.
During follow-up, patients in the HBI group had fewer unplanned 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=11).
Patients assigned to usual care were more likely to experience 3 or more readmissions for acute heart failure (P=02). (...)
Mots-clés Pascal : Insuffisance cardiaque, Surveillance, A domicile, Sortie hôpital, Récidive, Mort, Evaluation performance, Etude comparative, Homme, Appareil circulatoire pathologie, Cardiopathie
Mots-clés Pascal anglais : Heart failure, Surveillance, At home, Hospital discharge, Relapse, Death, Performance evaluation, Comparative study, Human, Cardiovascular disease, Heart disease
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0277838
Code Inist : 002B30A04D. Création : 27/11/1998.