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  • Standard vs. intensified management of heart failure to reduce healthcare costs: Results of a multicentre, randomized controlled trial

    Author(s)
    Scuffham, PA
    Ball, J
    Horowitz, JD
    Wong, C
    Newton, PJ
    Macdonald, P
    McVeigh, J
    Rischbieth, A
    Emanuele, N
    Carrington, MJ
    Reid, CM
    Chan, YK
    Stewart, S
    Griffith University Author(s)
    Scuffham, Paul A.
    Year published
    2017
    Metadata
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    Abstract
    Aims: To determine if an intensified form of heart failure management programme (INT-HF-MP) based on individual profiling is superior to standard management (SM) in reducing health care costs during 12-month follow-up (primary endpoint). Methods and results: A multicentre randomized trial involving 787 patients (full analysis set) discharged from four tertiary hospitals with chronic HF who were randomized to SM (n = 391) or INT-HF-MP (n = 396). Mean age was 74 ± 12 years, 65% had HF with a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling. Study groups were well matched. According to Green, Amber, Red ...
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    Aims: To determine if an intensified form of heart failure management programme (INT-HF-MP) based on individual profiling is superior to standard management (SM) in reducing health care costs during 12-month follow-up (primary endpoint). Methods and results: A multicentre randomized trial involving 787 patients (full analysis set) discharged from four tertiary hospitals with chronic HF who were randomized to SM (n = 391) or INT-HF-MP (n = 396). Mean age was 74 ± 12 years, 65% had HF with a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling. Study groups were well matched. According to Green, Amber, Red Delineation of rIsk And Need in HF (GARDIAN-HF) profiling, regardless of location, patients in the INT-HF-MP received a combination of face-to-face (home visits) and structured telephone support (STS); only 9% ('low risk') were designated to receive the same level of management as the SM group. The median cost in 2017 Australian dollars (A$1 equivalent to ∼EUR e0.7) of applying INT-HF-MP was significantly greater than SM ($152 vs. $121 per patient per month; P < 0.001), However, at 12 months, there was no difference in total health care costs for the INT-HF-MP vs. SM group (median $1579, IQR $644 to $3717 vs. $1450, IQR $564 to $3615 per patient per month, respectively). This reflected minimal differences in all-cause mortality (17.7% vs. 18.4%; P = 0.848) and recurrent hospital stay (18.6 ± 26.5 vs. 16.6 ± 24.8 days; P = 0.199) between the INT-HF-MP and SM groups, respectively. Conclusion: During 12-months follow-up, an INT-HF-MP did not reduce healthcare costs or improve health outcomes relative to SM.
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    Journal Title
    European Heart Journal
    Volume
    38
    Issue
    30
    DOI
    https://doi.org/10.1093/eurheartj/ehx259
    Subject
    Cardiovascular medicine and haematology
    Cardiovascular medicine and haematology not elsewhere classified
    Clinical sciences
    Science & Technology
    Life Sciences & Biomedicine
    Cardiac & Cardiovascular Systems
    Cardiovascular System & Cardiology
    Heart failure
    Publication URI
    http://hdl.handle.net/10072/408958
    Collection
    • Journal articles

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