ABSTRACT
INTRODUCTION AND OBJECTIVES: The objective of this study was to determine whether a home-based intervention can reduce mortality and hospital readmissions and improve quality of life in patients with heart failure. METHODS: A randomized clinical trial was carried out between January 2004 and October 2006. In total, 283 patients admitted to hospital with a diagnosis of heart failure were randomly allocated to a home-based intervention (intervention group) or usual care (control group). The primary end-point was the combination of all-cause mortality and hospital readmission for worsening heart failure at 1-year follow-up. RESULTS: The primary end-point was observed in 41.7% of patients in the intervention group and in 54.3% in the control group. The hazard ratio was 0.70 (95% confidence interval [CI] 0.55-0.99). Taking significant clinical variables into account slightly reduced the hazard ratio to 0.62 (95% CI 0.50-0.87). At the end of the study, the quality of life of patients in the intervention group was better than in the control group (18.57 vs. 31.11; P< .001). CONCLUSIONS: A home-based intervention for patients with heart failure reduced the aggregate of mortality and hospital readmissions and improved quality of life.
Subject(s)
Heart Failure/therapy , Home Care Services , Aged , Disease Progression , Endpoint Determination , Female , Follow-Up Studies , Heart Failure/mortality , Heart Failure/psychology , Hospitalization , Humans , Male , Proportional Hazards Models , Quality of LifeABSTRACT
Introducción y objetivos. El objetivo de este estudio es evaluar si una intervención domiciliaria reduce la mortalidad y los reingresos hospitalarios de pacientes con insuficiencia cardiaca y mejora su calidad de vida. Métodos. Ensayo clínico aleatorizado, realizado desde enero de 2004 a octubre de 2006. Se aleatorizó a 283 pacientes, diagnosticados de insuficiencia cardiaca e ingresados en el hospital, al grupo de atención domiciliaria (grupo intervención) o al grupo de atención habitual (grupo control). La variable principal de resultado se midió al año de seguimiento y fue la combinación de la mortalidad por todas las causas y los reingresos hospitalarios debido al empeoramiento de la insuficiencia cardiaca. Resultados. La variable principal se observó en el 41,7% de los pacientes del grupo intervención y en el 54,3% del grupo control. La razón de riesgos (HR) fue 0,70 (intervalo de confianza [IC] del 95%, 0,55-0,99). Incluyendo variables clínicas relevantes, la razón de riesgos disminuyó ligeramente (HR = 0,62; IC del 95%, 0,50-0,87). Al final del estudio, los pacientes del grupo intervención tenían una mejor calidad de vida que los pacientes del grupo control (18,57 frente a 31,11; p < 0,001). Conclusiones. Una intervención basada en la atención domiciliaria en pacientes con insuficiencia cardiaca reduce el conjunto de mortalidad y reingresos hospitalarios y mejora la calidad de vida (AU)
Introduction and objectives. The objective of this study was to determine whether a home-based intervention can reduce mortality and hospital readmissions and improve quality of life in patients with heart failure. Methods. A randomized clinical trial was carried out between January 2004 and October 2006. In total, 283 patients admitted to hospital with a diagnosis of heart failure were randomly allocated to a home-based intervention (intervention group) or usual care (control group). The primary end-point was the combination of all-cause mortality and hospital readmission for worsening heart failure at 1-year follow-up. Results. The primary end-point was observed in 41.7% of patients in the intervention group and in 54.3% in the control group. The hazard ratio was 0.70 (95% confidence interval [CI], 0.55-0.99). Taking significant clinical variables into account slightly reduced the hazard ratio to 0.62 (95% CI, 0.50-0.87). At the end of the study, the quality of life of patients in the intervention group was better than in the control group (18.57 vs 31.11; P < .001). Conclusions. A home-based intervention for patients with heart failure reduced the aggregate of mortality and hospital readmissions and improved quality of life (AU)
