TY  - JOUR
AU  - Scuffham, PA
AU  - Ball, J
AU  - Horowitz, JD
AU  - Wong, C
AU  - Newton, PJ
AU  - Macdonald, P
AU  - McVeigh, J
AU  - Rischbieth, A
AU  - Emanuele, N
AU  - Carrington, MJ
AU  - Reid, CM
AU  - Chan, YK
AU  - Stewart, S
Y2  - 2020/12/18
Y1  - 2017/08/07
SN  - 0195-668X
UR  - http://hdl.handle.net/11343/256134
AB  - 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 €0.7) 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.
LA  - English
PB  - OXFORD UNIV PRESS
T1  - Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial
DO  - 10.1093/eurheartj/ehx259
IS  - European Heart Journal
VL  - 38
IS  - 30
SP  - 2340-2348
L1  - /bitstream/handle/11343/256134/PMC5843128.pdf?sequence=1&isAllowed=y
ER  -