Prolonged Beneficial Effects of a Home-Based Intervention on Unplanned Readmissions and Mortality Among Patients With Congestive Heart Failure

Abstract

ALTHOUGH THE introduction of angiotensin-converting enzyme inhibitors has reduced morbidity and mortality rates among a large proportion of patients with congestive heart failure (CHF),^1-5 the cost of treating these patients still represents a disproportionately large component of health care expenditure worldwide.^6-11 Attempts to limit this expenditure (estimated to be upward of $10 billion per annum in the United States alone)¹¹ are confounded not only by the increasing prevalence of CHF^8,11-14 and the ongoing management it demands, but by the pattern of recurrent hospital use among a small subset of these patients.^6-8,15-22 The treatment of such "high-cost" patients is often complicated by a combination of advanced age, presence of major concomitant disease, and intractable symptoms despite maximal therapy; it is clear that a proportion of patients receive suboptimal treatment.^14,23-26 Two-year mortality among such patients is as high as 80%.^13,27