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

Scuffham, PA; Ball, J; Horowitz, JD; Won, C; Newton, PJ; Macdonald, P; McVeigh, J; Rischbieth, A; Emanuele, N; Carrington, MJ; Reid, CM; Chan, YK; Stewart, S

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

Scuffham, PA Ball, J Horowitz, JD Won, C Newton, PJ

Macdonald, P

McVeigh, J Rischbieth, A Emanuele, N Carrington, MJ Reid, CM Chan, YK Stewart, S

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Publication Type:: Journal Article
Citation:: European Heart Journal, 2017, 38 (30), pp. 2340 - 2348
Issue Date:: 2017-08-07

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Field	Value	Language
dc.contributor.author	Scuffham, PA	en_US
dc.contributor.author	Ball, J	en_US
dc.contributor.author	Horowitz, JD	en_US
dc.contributor.author	Won, C	en_US
dc.contributor.author	Newton, PJ https://orcid.org/0000-0002-5006-2037	en_US
dc.contributor.author	Macdonald, P https://orcid.org/0000-0001-5378-2825	en_US
dc.contributor.author	McVeigh, J	en_US
dc.contributor.author	Rischbieth, A	en_US
dc.contributor.author	Emanuele, N	en_US
dc.contributor.author	Carrington, MJ	en_US
dc.contributor.author	Reid, CM	en_US
dc.contributor.author	Chan, YK	en_US
dc.contributor.author	Stewart, S	en_US
dc.date.available	2017-04-27	en_US
dc.date.issued	2017-08-07	en_US
dc.identifier.citation	European Heart Journal, 2017, 38 (30), pp. 2340 - 2348	en_US
dc.identifier.issn	0195-668X	en_US
dc.identifier.uri	http://hdl.handle.net/10453/125072
dc.description.abstract	© The Author 2017. 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.	en_US
dc.relation.ispartof	European Heart Journal	en_US
dc.relation.isbasedon	10.1093/eurheartj/ehx259	en_US
dc.subject.classification	Cardiovascular System & Hematology	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Chronic Disease	en_US
dc.subject.mesh	Treatment Outcome	en_US
dc.subject.mesh	Hospitalization	en_US
dc.subject.mesh	Aged	en_US
dc.subject.mesh	Health Care Costs	en_US
dc.subject.mesh	Patient Care Team	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Heart Failure	en_US
dc.title	Standard vs. intensified management of heart failure to reduce healthcare costs: Results of a multicentre, randomized controlled trial	en_US
dc.type	Journal Article
utslib.citation.volume	30	en_US
utslib.citation.volume	38	en_US
utslib.for	1102 Cardiorespiratory Medicine and Haematology	en_US
utslib.for	1103 Clinical Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	open_access
pubs.issue	30	en_US
pubs.publication-status	Published	en_US
pubs.volume	38	en_US

Abstract:

© The Author 2017. 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.

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http://hdl.handle.net/10453/125072