Collaborative home-based palliative care for heart failure successful in UK

By Sarah Guy, medwireNews Reporter

A collaborative home-based palliative care service for patients with advanced congestive heart failure (CHF) could increase their chances of dying in their place of choice, show UK study results.

Furthermore, the service resulted in reduced inpatient admission rates, report the researchers.

The findings revealed lower overall expenditure among CHF patients who took part in the "Better Together" (BT) pilot study compared with their counterparts who did not (controls), with cost savings made in one case.

The collaborative team providing care under the pilot initiative included British Heart Foundation heart failure specialist nurses, Marie Curie Cancer Care nurses, and Marie Curie Cancer Care healthcare assistants who worked alongside cardiologists, "care of the elderly" consultants, district nurses, and general practitioners.

The approach was designed to "help identify and manage those who remain symptomatic and unstable despite optimal treatment," explain Jill Pattenden (University of York) and colleagues in BMJ Supportive and Palliative Care.

In all, 49 CHF patients from Bradford in the UK and 31 similar patients from Poole in the UK, all judged to be in their last year of life, received BT care at home between 2006 and 2008. Outcomes and costs were compared with 76 control CHF patients treated before the intervention was introduced.

Over two-thirds of patients receiving BT care died in their preferred place of care (home, hospice), at 70% in Bradford and 77% in Poole, note Pattenden et al. Corresponding figures for control patients were unavailable.

Also, fewer patients receiving BT care were admitted to hospital, compared with controls, with a 27.1% difference among patients in Bradford and a 17.7% difference among those in Poole. Only the former difference was statistically significant.

Mean costs of care per patient were higher at both sites for control compared with intervention patients, with a difference of £1190 (US$ 1857; € 1382) in Bradford and £850 ($ 1326; € 987) in Poole. Again, the difference was only significant in the Bradford data.

Overall, the cost of averting a hospital admission for heart failure as a result of BT care among patients in Bradford was £1529 ($ 2386; € 1775), while in Poole there was a net average cost-saving of £561 ($ 875; € 651) per admission averted.

"The BT intervention shows potential for both reducing NHS [National Health Service] costs and delivering benefits to patients," write the authors.

"While the findings are not sufficiently robust to support implementation of the intervention into routine care, there is a case for undertaking a more rigorous evaluation… to confirm or refute these findings," they conclude.

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