• Vol. 42 No. 9, 466–471
  • 15 September 2013

Home-Based Advance Care Programme is Effective in Reducing Hospitalisations of Advanced Heart Failure Patients: A Clinical and Healthcare Cost Study



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Introduction: In end-stage heart failure (HF) that is not eligible for mechanical assist device or heart transplant, palliative care serves to maximise symptom control and quality of life. We sought to evaluate the impact of home-based advance care programme (ACP) on healthcare utilisation in end-stage HF patients.

Materials and Methods: Prospectively collected registry data on all end-stage HF recruited into ACP between July 2008 and July 2010 were analysed. Chart reviews were conducted on HF database and hospital electronic records. Phone interview and home visit details by ACP team were extracted to complete data entry. HF and all-cause hospitalisations 1 year before, and any time after ACP inception were defined as events. For the latter analysis, follow-up duration adjustment to event episodes was performed to account for death less than a year.

Results: Forty-four patients (mean age 79 years, 39% men) were followed up for 15±8 months. Fifty-seven percent had diabetes, 80% ischaemic heart disease, and 60% chronic kidney disease. All reported functional class III/IV at enrolment. Mean serum sodium was 136±6 mmol/L, and creatinine 186±126 mmol/L. Thirty (68%) died within the programme. Mean time to death was 5.5 months. Mean all-cause and HF hospitalisations were 3.6 and 2.0 per patient before enrolment, but improved to 1.0 and 0.6 respectively after ACP. Thirty-six (71%) patients had fewer HF hospitalisations. When only those who survived more than a year were considered (n = 14), 10 (71%) and 9 (64%) experienced reduced HF (mean: 1.4 episodes per patient) and all-cause hospitalisations (mean: 2.2 episodes per patient) respectively.

Conclusion: Home-based advance care programme is potentially effective in reducing healthcare utilisation of end-stage HF patients, primarily by reducing HF rehospitalisations, and in probably saving costs as well.

Advanced heart failure (HF) is a debilitating chronic disease that negatively impacts patients’ quality of life (QOL) and is associated with high mortality rates. The economic burden from HF is substantial to both healthcare system and to individuals and their families. It is associated with recurrent hospitalisation for HF exacerbations2 and
the need for intravenous vasoactive treatment that becomes increasingly frequent. In our prior publication, we found high mortality mirroring that of western figures among
unselect cohort of HF patients.8 In end-stage HF not eligible for heart transplantation or destination mechanical assist device, palliative care complementing a chronic disease
management programme serves to optimise symptom controls and address multiple domains of patient and family distress, albeit some deficiencies in hard clinical evidence.

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