Abstract
AIMS: Hospitalisation at home (HaH) achieves comparable health outcomes to conventional in-patient care, in terms of cost-effectiveness and quality of life. Our objective was to assess the impact of episodes of acute decompensation of heart failure (ADCHF) on functional status and quality of life, in patients under HaH care compared with a matched group receiving conventional in-patient care at a Cardiology ward (CW). Methods: Randomised clinical trial in 71 patients with ADCHF attending the Emergency Department. Patients were either admitted to the hospital’s CW or to the HaH service. The functional status and health related quality of life (HRQOL) were assessed using the Barthel Index (BI) and the EQ-5D, Short Form-36 (SF-36) and Minnessota Living with Heart Failure (MLHFQ) questionnaires, administered at admission and, depending on the test, at discharge and 1, 3, 6 and 12 months after discharge. Results: MLHFQ and SF-36 experienced significant improvement in most domains with respect to the initial values at discharge and 6 months after only in the HaH group; though by 12-months there were no significant differences. Barthel Index and EQ-5D value scores showed improvement with respect to initial values in both arms. The improvement could be appreciated in more components and for longer among the HaH patients. Conclusions: Functional independence and quality of life improve at discharge compared to admission, after both home-based and in-patient hospitalisation, outcomes being better in various respects over the first year of follow-up after hospital-at-home care.
Highlights
Heart failure (HF) is one of the main health problems today in Western countries, given its high prevalence, with associated morbidity and mortality, increasing with age
Our objective was to assess the impact of episodes of acute decompensation of heart failure (ADCHF) on functional status and quality of life, in patients under Hospitalisation at home (HaH) care compared with a matched group receiving conventional in-patient care at a Cardiology ward (CW)
The functional status and health related quality of life (HRQOL) were assessed using the Barthel Index (BI) and the EQ-5D, Short Form-36 (SF-36) and Minnessota Living with Heart Failure (MLHFQ) questionnaires, administered at admission and, depending on the test, at discharge and 1, 3, 6 and 12 months after discharge
Summary
Heart failure (HF) is one of the main health problems today in Western countries, given its high prevalence, with associated morbidity and mortality, increasing with age It is one of the chronic diseases with the greatest impact on health-related quality of life (HRQOL) [1]. The main objective of hospital at home (HaH) services is to reduce hospitalisations, by delivering in the home setting a care of a comparable intensity and complexity to that provided to inpatients while achieving equivalent clinical outcomes This translates to reductions in healthcare costs, lower rates of hospital-related complications (nosocomial infections, thrombotic diseases and delirium) and increased comfort for patients and their families [3,4]. The key results include: a reduction in the frequency of decompensation in the period following HaH care, compared to previous months [5]; comparable clinical effectiveness to conventional hospitalisation [6,7,8,9]; and lower direct healthcare
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