BACKGROUND: It is not known to what extent initially observed benefits of postdischarge programs of care for patients with chronic congestive heart failure (CHF) in respect to event-free survival, readmissions, and healthcare costs persist in the long term. METHODS AND RESULTS: We prospectively studied the long-term effects of a multidisciplinary home-based intervention (HBI) in a cohort of CHF patients randomly allocated to either to HBI (n = 149) or usual care (n = 148). During a median of 4.2 years of follow-up, there were significantly fewer primary end points (unplanned readmission or death) in the HBI versus usual care group: a mean of 0.21 versus 0.37 primary events per patient per month (p < 0.01). Median event-free survival was more prolonged in the HBI than usual care group (7 versus 3 months; p < 0.01). Fewer HBI patients died (56% versus 65%; p = 0.06) and had more prolonged survival (a median of 40 versus 22 months; p < 0.05) compared with usual care. Assignment to HBI was both an independent predictor of event-free survival (RR 0.70; p < 0.01) and survival alone (RR 0.72; p < 0.05). Overall, HBI patients had 78 fewer unplanned readmissions compared with usual care (0.17 versus 0.29 readmissions per patient per month; p < 0.05). The median cost of these readmissions was $A325 versus $A660/month per HBI and usual care patient (p < 0.01). CONCLUSIONS: The beneficial effects of HBI in reducing frequency of unplanned readmissions in CHF patients persist in the long term and are associated with prolongation of survival.
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