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

P. A. Scuffham, J. Ball, J. D. Horowitz, C. Won, P. J. Newton, P. Macdonald, J. McVeigh, A. Rischbieth, N. Emanuele, M. J. Carrington, C. M. Reid, Y. K. Chan, S. Stewart

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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 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.

Original languageEnglish
Pages (from-to)2340-2348
Number of pages9
JournalEuropean Heart Journal
Volume38
Issue number30
DOIs
Publication statusPublished - 7 Aug 2017
Externally publishedYes

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Keywords

  • Healthcare costs
  • Heart failure
  • Hospitalization
  • Mortality
  • Multidisciplinary management
  • Nurse-led

Cite this

Scuffham, P. A., Ball, J., Horowitz, J. D., Won, C., Newton, P. J., Macdonald, P., McVeigh, J., Rischbieth, A., Emanuele, N., Carrington, M. J., Reid, C. M., Chan, Y. K., & Stewart, S. (2017). Standard vs. intensified management of heart failure to reduce healthcare costs: Results of a multicentre, randomized controlled trial. European Heart Journal, 38(30), 2340-2348. https://doi.org/10.1093/eurheartj/ehx259