Heart failure management at home: a non-randomised prospective case-controlled trial (HeMan at Home)

Area of Science:

• Cardiology
• Healthcare Management
• Public Health

Background:

• Heart failure (HF) presents a significant and growing clinical and economic challenge.
• The COVID-19 pandemic exacerbated HF patient care issues, leading to increased morbidity and mortality.
• Evaluating alternative care models like Hospital at Home (HAH) is crucial for managing acute on chronic HF (CHF).

Purpose of the Study:

• To assess the quality and safety of the Hospital at Home (HAH) model for acute on chronic heart failure (CHF) patients.
• To compare HAH with usual hospital care (UC) regarding patient outcomes and satisfaction.
• To determine the feasibility of HAH as an alternative to traditional inpatient admission.

Main Methods:

• A prospective, non-randomized case-controlled study comparing HAH and usual care (UC) for CHF patients.
• Primary outcomes included length of stay (LOS), adverse events, discharge disposition, and patient satisfaction.
• Secondary outcomes assessed 30-day readmission rates, emergency department (ED) usage, and ED dwell time.

Main Results:

• HAH patients experienced fewer adverse events (12.5% vs. 35%) and higher patient satisfaction than UC patients.
• Length of stay was slightly longer in HAH (6.3 days vs. 4.7 days), but readmission and ED usage rates were similar.
• Patients in the HAH program were less likely to require post-acute services after discharge.

Conclusions:

• The Hospital at Home (HAH) pilot program proved to be a safe and effective care alternative for selected acute on chronic heart failure patients.
• HAH offers a viable option to reduce adverse events and improve patient satisfaction without increasing readmissions.
• This model demonstrates potential for optimizing care delivery and resource utilization in heart failure management.