Standard vs. Intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial
Journal article
Scuffham, Paul, Ball, Jocasta, Horowitz, John, Wong, C., Newton, P J., MacDonald, P., McVeigh, J., Rischbieth, Amanda, Emanuele, N., Carrington, Melinda, Reid, C. M., Chan, Kai and Stewart, Simon. (2017). Standard vs. Intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial. European Heart Journal. 38(30), pp. 2340 - 2348. https://doi.org/10.1093/eurheartj/ehx259
Authors | Scuffham, Paul, Ball, Jocasta, Horowitz, John, Wong, C., Newton, P J., MacDonald, P., McVeigh, J., Rischbieth, Amanda, Emanuele, N., Carrington, Melinda, Reid, C. M., Chan, Kai and Stewart, Simon |
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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 €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. |
Year | 2017 |
Journal | European Heart Journal |
Journal citation | 38 (30), pp. 2340 - 2348 |
Publisher | Oxford University Press |
ISSN | 0195-668X |
Digital Object Identifier (DOI) | https://doi.org/10.1093/eurheartj/ehx259 |
Scopus EID | 2-s2.0-85032821894 |
Open access | Open access |
Page range | 2340 - 2348 |
Research Group | Mary MacKillop Institute for Health Research |
Publisher's version | |
Place of publication | United Kingdom |
Editors | T. F. Lüscher |
https://acuresearchbank.acu.edu.au/item/881y0/standard-vs-intensified-management-of-heart-failure-to-reduce-healthcare-costs-results-of-a-multicentre-randomized-controlled-trial
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