Intensive home-care surveillance prevents hospitalization and improves morbidity rates among elderly patients with severe congestive heart failure

The purpose of this study was to examine the impact of intensive home-care surveillance on morbidity rates of elderly patients with severe congestive heart failure. Forty-two patients aged 78 ± 8 years who had severe congestive heart failure (New York Heart Association functional classes III through IV, mean ejection fraction 27% ± 6%), were examined at least once a week at home by intermists from the district hospital and by a trained paramedical team. The year before entry to the home-care program was compared to the first year of home surveillance. The mean total hospitalization (hosp) rate was reduced from 3.2 ± 1.5 hosp/yr to 1.2 ± 1.6 hosp/yr and duration from 26 ± 14 days/yr to 6 ± 7 days/yr (p < 0.001 for both). Cardiovascular admissions decreased from 2.9 ± 1.5 hosp/yr to 0.8 ± 1.1 hosp/yr and duration from 23 ± 13 days/yr to 4 ± 4 days/yr (p < 0.001). The vital status (ability to perform daily activities, expressed in a 1 to 4 scale) was improved from 1.4 ± 0.9 to 2.3 ± 0.7 (p < 0.001). In conclusion, an intensive home-care program was associated with a marked decrease in the need for hospitalization and improved the functional status of elderly patients with severe congestive heart failure. Such a service might also have a cost-effective advantage and a major impact on health expenditure.