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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EA composite analysis was conducted of 3 randomized trials of home-based interventions compared with standard care in patients with cardiac disease. Home-based intervention resulted in a shorter hospital stay, better survival, and prolonged days alive and out of the hospital but should be reserved for clinically complex cases to avoid harm.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eacute coronary syndrome\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eatrial fibrillation\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecomposite analysis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eheart failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehome-based intervention\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehospital stay\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estandard of care\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EDetermining the optimal disease management strategies for patients with cardiovascular (CV) disease is an ongoing area of research. Several studies comparing a nurse-led home-based intervention (HBI) with standard care (SC) in patients with chronic heart disease have recently been completed. Simon Stewart, MD, PhD, Australian Catholic University, Melbourne, Australia, presented the results of a composite analysis of 3 randomized trials: the WHICH? trial [Stewart S et al. \u003Cem\u003EInt J Cardiol\u003C\/em\u003E. 2014], the SAFETY trial [Stewart S et al. \u003Cem\u003ELancet\u003C\/em\u003E. 2015], and the NIL-CHF study [Stewart S et al. \u003Cem\u003EEur J Heart Fail\u003C\/em\u003E. 2015]. The hypothesis was that HBI would be superior to high levels of SC in the prevention of repeated hospitalizations and premature mortality and that the effectiveness of HBI would increase as the complexity of the clinical cases increased.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe 3 trials enrolled patients across the spectrum of cardiac disease. The WHICH? trial enrolled patients with heart failure (HF) with reduced ejection fraction and preserved ejection fraction, the SAFETY trial enrolled patients with chronic atrial fibrillation without HF, and the NIL-CHF study enrolled cardiac patients, most with acute coronary syndrome, without HF. In all of the studies, patients were recruited during acute hospitalization before returning home. All 3 trials were compliant with the Consolidated Standards of Reporting Trials, had independent data management and statistical analysis, and had blinded end point acquisition and adjudication. Follow-up ranged from 2 years (SAFETY) to 3 years (WHICH? and NIL-CHF).\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EA total of 1226 patients were analyzed, of which 612 received HBI and 614 received SC. The demographics of the study cohort were well matched across interventions. Patients were older (approximately 70 years), had multiple comorbidities and high clinical complexity, and had received appropriate levels of treatment. Thirty percent of patients were women.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003ESeveral aspects of recurrent hospital stays significantly favored HBI, including the median length of stay per patient in unplanned admission days (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.011), CV admission days (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.039), and all admissions (days in the hospital; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.017). Further, all-cause mortality was lower with HBI vs SC (15.4% vs 20.2%; adjusted HR, 0.56; 95% CI, 0.41 to 0.78; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.001). Patients in the HBI group also achieved a mean of 1210\u2005\u00b1\u2005463 days alive and out of the hospital (90.1%; 95% CI, 88.2 to 92.0) compared with 1184\u2005\u00b1\u2005494 days event free in the SC group (87.2%; 95% CI, 85.1 to 89.3; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.02).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EHBI was associated with worse event-free survival in lower clinical complexity cases, and Dr Stewart noted that HBI worked best when the clinical complexity was increased. Accordingly, to reduce the chance for harm, HBI should be reserved for cases that are more clinically complex.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ELimitations of this study include that it was a post hoc analysis of studies in which the participants were not blinded. The mechanisms through which HBI increases events at low clinical complexity and benefits cases of high clinical complexity need to be further explored.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/28\/14.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl4ke\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}