Cost effective management programme for heart failure reduces hospitalisation

Abstract

Objective—To study the effects of a management programme on hospitalisation and health care costs one year after admission for heart failure. Design—Prospective, randomised trial. Setting—University hospital with a primary catchment area of 250 000 inhabitants. Patients—190 patients (aged 65-84 years, 52.3% men) hospitalised because of heart failure. Intervention—Two types of patient management were compared. The intervention group received education on heart failure and self management, with follow up at an easy access, nurse directed outpatient clinic for one year after discharge. The control group was managed according to routine clinical practice. Main outcome measures—Time to readmission, days in hospital, and health care costs during one year. Results—The one year survival rate was 71.8% (n = 79) in the control group and 70.0% (n = 56) in the intervention group (NS). The mean time to readmission was longer in the intervention group than in the control group (141 (87) v 106 (101); p < 0.05) and number of days in hospital tended to be fewer (4.2 (7.8) v 8.2 (14.3); p = 0.07). There was a trend towards a mean annual reduction in health care costs per patient of US$1300 (US$1 = SEK 7.76) in the intervention group compared with costs in the controls (US$3594 v 2294; p = 0.07). Conclusions—A management programme for patients with heart failure discharged after hospitalisation reduces health care costs and the need for readmission. Keywords: heart failure; hospitalisation; management; health care costs; nurse led clinics