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dc.contributor.authorStewart, Simonen_US
dc.contributor.authorJ. Carrington, Melindaen_US
dc.contributor.authorH. Marwick, Thomasen_US
dc.contributor.authorM. Davidson, Patriciaen_US
dc.contributor.authorMacdonald, Peteren_US
dc.contributor.authorD. Horowitz, Johnen_US
dc.contributor.authorKrum, Henryen_US
dc.contributor.authorJ. Newton, Phillipen_US
dc.contributor.authorReid, Christopheren_US
dc.contributor.authorChan, Yih Kaien_US
dc.contributor.authorScuffham, Paulen_US
dc.date.accessioned2017-05-03T14:20:20Z
dc.date.available2017-05-03T14:20:20Z
dc.date.issued2012en_US
dc.date.modified2013-06-17T02:57:06Z
dc.identifier.issn07351097en_US
dc.identifier.doi10.1016/j.jacc.2012.06.025en_US
dc.identifier.urihttp://hdl.handle.net/10072/47731
dc.description.abstractObjectives The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure (CHF) management. Background Although direct patient contact appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear. Methods This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71 14 years, and 73% with left ventricular ejection fraction 45%) randomized to home-based intervention (HBI) or specialized CHF clinic-based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs. Results The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio [HR]: 0.97 [95% confidence interval (CI): 0.73 to 1.30], p 0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p 0.887), and 31 (21.7%) versus 38 (27.7%) died (p 0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 [interquartile range (IQR): 2.0 to 7.0] days vs. 6.0 [IQR: 3.5 to 13] days; p 0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 [95% CI: 1.37 to 4.73], p 0.003). HBI was associated with significantly fewer days of all-cause hospitalization ( 35%; p 0.003) and from cardiovascular causes ( 37%; p 0.025) but not for CHF ( 24%; p 0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 [IQR: 13 to 81] per day vs. $AU52 [17 to 140] per day; p 0.030). Conclusions HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was associated with significantly lower healthcare costs, attributable to fewer days of hospitalization.en_US
dc.description.peerreviewedYesen_US
dc.description.publicationstatusYesen_US
dc.languageEnglishen_US
dc.language.isoen_US
dc.publisherElsevieren_US
dc.publisher.placeUnited Statesen_US
dc.relation.ispartofstudentpublicationNen_US
dc.relation.ispartofpagefrom1239en_US
dc.relation.ispartofpageto1248en_US
dc.relation.ispartofissue14en_US
dc.relation.ispartofjournalJournal of the American College of Cardiologyen_US
dc.relation.ispartofvolume60en_US
dc.rights.retentionYen_US
dc.subject.fieldofresearchMedical and Health Sciences not elsewhere classifieden_US
dc.subject.fieldofresearchcode119999en_US
dc.titleImpact of Home Versus Clinic-Based Management of Chronic Heart Failure: The WHICH? (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care) Multicenter, Randomized Trialen_US
dc.typeJournal articleen_US
dc.type.descriptionC1 - Peer Reviewed (HERDC)en_US
dc.type.codeC - Journal Articlesen_US
gro.date.issued2012
gro.hasfulltextNo Full Text


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