BACKGROUND: The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown. METHODS AND RESULTS: The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n = 149) or usual postdischarge care (UC) (n = 148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; p < 0.001), with fewer deaths overall (HBI 77% versus 89%; adjusted relative risk 0.74; 95% CI 0.53 to 0.80; p < 0.001). HBI was associated with prolonged event-free survival (median 7 versus 4 months; p < 0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04 +/- 3.23 versus 3.66 +/- 7.62 admissions; p < 0.05) and related hospital stay (14.8 +/- 23.0 versus 28.4 +/- 53.4 days per patient per year; p < 0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of $1,729 per additional life-year gained when we accounted for healthcare costs including the HBI. CONCLUSIONS: In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.
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