• Frances Kam Yuet Wong, NgAlina Yee ManAYSchool of Nursing, The Hong Kong Polytechnic University, Hong Kong, China., Paul Hong Lee, Po-Tin Lam, NgJeffrey Sheung ChingJSDepartment of Medicine, Haven of Hope Hospital, Hong Kong, China., NgNancy Hiu YimNHDepartment of Medicine and Geriatrics, United Christian Hospital, Hong Kong, China., and Michael Mau Kwong Sham.
• School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China.
• Heart. 2016 Jul 15; 102 (14): 1100-8.

ObjectiveTo examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge.MethodsThis 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).ResultsThe 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.ConclusionsThis 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 NumberHKCTR-1562; Results.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

26 keywords...

hide…