The WHICH? Trial: Rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients

Stewart, S; Carrington, MJ; Marwick, T; Davidson, PM; MacDonald, P; Horowitz, J; Krum, H; Newton, PJ; Reid, C; Scuffham, PA

The WHICH? Trial: Rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients

Stewart, S Carrington, MJ Marwick, T Davidson, PM

MacDonald, P

Horowitz, J Krum, H Newton, PJ

Reid, C Scuffham, PA

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Publication Type:: Journal Article
Citation:: European Journal of Heart Failure, 2011, 13 (8), pp. 909 - 916
Issue Date:: 2011-08-01

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Field	Value	Language
dc.contributor.author	Stewart, S	en_US
dc.contributor.author	Carrington, MJ	en_US
dc.contributor.author	Marwick, T	en_US
dc.contributor.author	Davidson, PM https://orcid.org/0000-0003-2050-1534	en_US
dc.contributor.author	MacDonald, P https://orcid.org/0000-0001-5378-2825	en_US
dc.contributor.author	Horowitz, J	en_US
dc.contributor.author	Krum, H	en_US
dc.contributor.author	Newton, PJ https://orcid.org/0000-0002-5006-2037	en_US
dc.contributor.author	Reid, C	en_US
dc.contributor.author	Scuffham, PA	en_US
dc.date.issued	2011-08-01	en_US
dc.identifier.citation	European Journal of Heart Failure, 2011, 13 (8), pp. 909 - 916	en_US
dc.identifier.issn	1388-9842	en_US
dc.identifier.uri	http://hdl.handle.net/10453/29487
dc.description.abstract	Aims To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. Methods WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patients own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 1218 months of follow-up. Of 688 eligible patients, 280 patients (73 male and 66 principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n 143) or clinic-based (n 137) post-discharge management. This will provide 80 power (two-sided alpha of 0.05) to detect a 15 absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63), coronary artery disease (55), and atrial fibrillation (53) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Perspective Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: journals.permissionsoup.com.2011 © Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: journals.permissionsoup.com.	en_US
dc.relation.ispartof	European Journal of Heart Failure	en_US
dc.relation.isbasedon	10.1093/eurjhf/hfr048	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	Ambulatory Care	en_US
dc.subject.mesh	Research Design	en_US
dc.subject.mesh	Outpatient Clinics, Hospital	en_US
dc.subject.mesh	Home Care Services	en_US
dc.subject.mesh	Cost-Benefit Analysis	en_US
dc.subject.mesh	Heart Failure	en_US
dc.title	The WHICH? Trial: Rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients	en_US
dc.type	Journal Article
utslib.citation.volume	8	en_US
utslib.citation.volume	13	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1102 Cardiorespiratory Medicine and Haematology	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/Faculty of Health/Nursing
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	closed_access
pubs.issue	8	en_US
pubs.publication-status	Published	en_US
pubs.volume	13	en_US

Abstract:

Aims To describe the rationale and design of the Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial. Methods WHICH? is a pragmatic, multicentre, randomized controlled trial that seeks to determine if multidisciplinary management of chronic heart failure (CHF) patients post-acute hospitalization delivered in a patients own home is superior to care delivered via a specialist CHF outpatient clinic. The composite primary endpoint is all-cause, unplanned recurrent hospitalization or death during 1218 months of follow-up. Of 688 eligible patients, 280 patients (73 male and 66 principal diagnosis of CHF) with a mean age of 71 ± 14 years have been randomized to home- (n 143) or clinic-based (n 137) post-discharge management. This will provide 80 power (two-sided alpha of 0.05) to detect a 15 absolute difference in both the primary end-point and rate of all-cause hospital stay. Preliminary data suggest that the two groups are well matched in nearly all baseline socio-economic and clinical parameters. The majority of patients have significant co-morbidity, including hypertension (63), coronary artery disease (55), and atrial fibrillation (53) with an accordingly high Charlson Index of Comorbidity Score (6.1 ± 2.4). Perspective Despite its relatively small size, the WHICH? trial is well placed to examine the relative impact of two of the most commonly applied forms of face-to-face management designed to reduce recurrent hospitalization and prolong survival in CHF patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: journals.permissionsoup.com.2011 © Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2011. For permissions please email: journals.permissionsoup.com.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/29487