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Home-based management for CHF has long-term benefits

Cardiovascular medicine

Cardiovascular medicine

?The long-term effectiveness of community-based heart failure management programs has not been well established.

A recently published Australian study has now provided evidence for nurse-led, multidisciplinary, home-based intervention in elderly patients with chronic heart failure (CHF).

The study investigated 297 patients >55 years of age who had a confirmed diagnosis of CHF and at least one prior admission for acute heart failure.

The patients were divided into two groups. A total of 149 patients were allocated to home-based intervention, of whom 130 actually received the intervention, and 148 to usual care. The two groups were well matched, with a mean ejection fraction of 38 per cent. Most were in NYHA functional class II/III and on appropriate medical therapy.

The intervention group had an initial home visit by a specialist nurse, access to telephone follow-up and support from a community pharmacist above usual care.

Patients were followed up for 7.5 to 10 years. The key end points were all-cause mortality and recurrent hospital admissions (number, length and type).

Any long-term study of patients with chronic heart failure will have high mortality rates, but there was still a significant benefit to be seen with home-based intervention.

The intervention group had a median survival of 40 months, compared with 22 months in the usual care group. There was a significant reduction in the rate and length of admissions in the short and medium term. Finally, the cost per life year saved was felt to be very competitive compared with other accepted treatment strategies.

Although there were limitations to this study, the results certainly cannot be ignored and are encouraging, coming at a time when there is gathering enthusiasm for community-based heart failure nurse specialists.

Inglis S, Pearson S, Treen S, et al. Extending the horizon in Chronic Heart Failure: Effects of multidisciplinary, home-based intervention relative to usual care Circulation 2006;114:2466-2473

Dr Peter Savill

GPSI Cardiology, Southampton

Dr Peter Savill

GPSI Cardiology, Southampton

Reviewer

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