Does Nurse Led Home Based Interventions Improve Survival in Complex CVD Cases?

Nurse-led, multidisciplinary home-based intervention was associated with significantly less hospital stay, significantly better survival and significantly prolonged days alive and out-of-hospital, according to a study presented Aug. 30 at ESC Congress 2015 in London.

The study was based on analysis of three recently reported clinical trials addressing home-based intervention – the WHICH?, SAFETY and NIL-CHF trials. The primary endpoint was the proportion of actual vs. maximal days alive and out-of-hospital, while the secondary endpoints were all-cause mortality and rate of hospitalization/hospital stay.

Of the 1,226 subjects, 809 were men and 417 women. All were randomized to home-based intervention (n=612) or to standard post-discharge (n=614) with groups well-matched for baseline profiles. The most common reasons for hospitalization were atrial fibrillation (20 percent), acute coronary syndrome (19 percent) and acute heart failure (17 percent). Researchers noted that roughly one-third of cases were complicated by concurrent diabetes, depression, anemia and/or renal dysfunction. Patients in the home-based intervention group experienced 1210±463 days alive and free from unplanned hospitalization, compared to those in the standard care group who experienced 1184±494 days alive and out-of-hospital.

Rates of all-cause, unplanned and cardiovascular-related hospitalizations all favored home-based intervention. Additionally, home-based intervention was associated with significantly prolonged survival independent of other covariates like age, comorbidity score, renal function or presence of AFib and/or hypertension.

"Overall, home-based intervention is associated with significantly improved event-free survival due to prolonged all-cause survival and fewer days of unplanned hospital stay," the study authors conclude. "However, a gradient response to home-based intervention suggests it can be selectively applied in more complex cases."

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Hypertension

Keywords: Acute Coronary Syndrome, Anemia, Atrial Fibrillation, Comorbidity, Depression, Diabetes Mellitus, Disease-Free Survival, Heart Failure, Hospitalization, Hypertension, Patient Discharge, ESC Congress

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