Effects of a nurse‐led, clinic and home‐based intervention on recurrent hospital use in chronic heart failure

Background: Few studies have examined the potential benefits of specialist nurse‐led programs of care involving home and clinic‐based follow‐up to optimise the post‐discharge management of chronic heart failure (CHF). Objective: To determine the effectiveness of a hybrid program of clinic plus home‐based intervention (C+HBI) in reducing recurrent hospitalisation in CHF patients. Methods: CHF patients with evidence of left ventricular systolic dysfunction admitted to two hospitals in Northern England were assigned to a C+HBI lasting 6 months post‐discharge ( n =58) or to usual, post‐discharge care (UC: n =48) via a cluster randomization protocol. The co‐primary endpoints were death or unplanned readmission (event‐free survival) and rate of recurrent, all‐cause readmission within 6 months of hospital discharge. Results: During study follow‐up, more UC patients had an unplanned readmission for any cause (44% vs. 22%: P =0.019, OR 1.95 95% CI 1.10–3.48) whilst 7 (15%) versus 5 (9%) UC and C+HBI patients, respectively, died ( P =NS). Overall, 15 (26%) C+HBI versus 21 (44%) UC patients experienced a primary endpoint. C+HBI was associated with a non‐significant, 45% reduction in the risk of death or readmission when adjusting for potential confounders (RR 0.55, 95% CI 0.28–1.08: P =0.08). Overall, C+HBI patients accumulated significantly fewer unplanned readmissions (15 vs. 45: P <0.01) and days of recurrent hospital stay (108 vs. 459 days: P <0.01). C+HBI was also associated with greater uptake of beta‐blocker therapy (56% vs. 18%: P <0.001) and adherence to Na restrictions ( P <0.05) during 6‐month follow‐up. Conclusion: This is the first randomised study to specifically examine the impact of a hybrid, C+HBI program of care on hospital utilisation in patients with CHF. Its beneficial effects on recurrent readmission and event‐free survival are consistent with those applying either a home or clinic‐based approach.