Abstract
Importance: Heart failure (HF) is the leading cause of hospitalization among patients over the age of 65 in the United States and developed countries, posing a significant economic burden to the health care systems. More than half of the patients with HF will be readmitted to the hospital within 6 months from discharge, leading not only to increased health care related expenses but also functional decline, iatrogenic injuries and in-hospital infections. With the increasing prevalence of HF, there is a substantial need for innovative delivery care models that can provide hospital level of care at a patient’s home. Observations: Home hospitalization was originally used to safely manage chronically ill patients with general medical (stroke, chronic obstructive pulmonary disease, deep vein thrombosis, community acquired pneumonia) and surgical conditions and was associated with improved patient satisfaction and improvement in activity of daily living status. This had no clear effect on readmission or cost. When hospital at home care model was applied to HF patients it demonstrated increased time to readmission, reduced index costs and improved health related quality of life, with no significant differences in adverse events. Eligible patients should be selected based on multiple factors taking into consideration applicable limitations and comorbidities. Conclusions and Relevance: Providing in-hospital level care to the patient’s house presents a reliable alternative, yielding multiple benefits both for the patient, as well as the health care system. Formulating a well-defined model is necessary before wide implementation.
Highlights
Heart failure (HF) is a life-threatening progressive disease, the leading cause of hospitalization among patients over the age of 65 in the United States and developed countries and remains an epidemic worldwide [1,2]
Data might be collected continuously or multiple times throughout the day and may include blood pressure, heart rate, electrocardiogram (ECG), or a variety of indicators for housebound patients. Such systems can be used to facilitate health care provided by physicians or home visiting nurses [20], the effectiveness of Remote patient monitor (RPM) programs in reducing mortality or the number of cardiovascular hospitalizations compared with usual care is not currently established [21,22]
Acute Decompensated Heart Failure National Registry (ADHERE) [39] reaffirmed the prognostic importance of systolic blood pressure, blood urea nitrogen and/or serum creatinine concentration and hyponatremia for death occurring within 60 days from presentation
Summary
Heart failure (HF) is a life-threatening progressive disease, the leading cause of hospitalization among patients over the age of 65 in the United States and developed countries and remains an epidemic worldwide [1,2]. In the USA, overall costs of heart failure in 2012 was estimated to be $30.7 billion. Of this total, 68% was attributable to direct medical costs [7]. With the increasing prevalence of HF, there is a substantial need to explore innovative delivery care models, other than acute care hospitalization. These models will ideally provide optimal care and outcome, patient, family and provider satisfaction as well as reduced cost of health care provision and prevent disruption in heart failure care. Home-hospitalization provides significant opportunities to deliver on the needs of caring for HF patients more comprehensively and bears review and intense study
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