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Randomized Controlled Trial
. 2016 Jul 15;102(14):1100-8.
doi: 10.1136/heartjnl-2015-308638. Epub 2016 Mar 11.

Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial

Frances Kam Yuet Wong  1 , Alina Yee Man Ng  1 , Paul Hong Lee  1 , Po-Tin Lam  2 , Jeffrey Sheung Ching Ng  3 , Nancy Hiu Yim Ng  2 , Michael Mau Kwong Sham  4
Affiliations
Randomized Controlled Trial

Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial

Frances Kam Yuet Wong et al. Heart. .

Abstract

Objective: To examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge.

Methods: This was a randomised controlled trial conducted in three hospitals in Hong Kong. The recruited subjects were patients with ESHF who had been discharged home from hospitals and referred for palliative service, and who met the specified inclusion criteria. The interventions consisted of weekly home visits/telephone calls in the first 4 weeks then monthly follow-up, provided by a nurse case manager supported by a multidisciplinary team. The primary outcome measures were any readmission and count of readmissions within 4 and 12 weeks after index discharge, compared using χ(2) tests and Poisson regression, respectively. Secondarily, change in symptoms over time between control and intervention groups were evaluated using generalised estimating equation analyses of data collected using the Edmonton Symptom Assessment Scale (ESAS).

Results: The intervention group (n=43) had a significantly lower readmission rate than the control group (n=41) at 12 weeks (intervention 33.6% vs control 61.0% χ(2)=6.8, p=0.009). The mean number (SE) of readmissions for the intervention and control groups was, respectively, 0.42 (0.10) and 1.10 (0.16) and the difference was significant (p=0.001). The relative risk (CI) for 12-week readmissions for the intervention group was 0.55 (0.35 to 0.88). There was no significant difference in readmissions between groups at 4 weeks. However, when compared with the control group, the intervention group experienced significantly higher clinical improvement in depression (45.9% vs 16.1%, p<0.05), dyspnoea (62.2% vs 29.0%, p<0.05) and total ESAS score (73.0% vs 41.4%, p<0.05) at 4 weeks. There were significant differences between groups in changes over time in quality of life (QOL) measured by McGill QOL (p<0.05) and chronic HF (p<0.01) questionnaires.

Conclusions: This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF.

Trial registration number: HKCTR-1562; Results.

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Figures

Figure 1
Figure 1
CONSORT flow diagram of the study. CONSORT;Consolidated Standards of Reporting Trials.
See this image and copyright information in PMC

Comment in

References

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