A multicenter, randomized trial of a nurse-led, home-based intervention for optimal secondary cardiac prevention suggests some benefits for men but not for women: the Young at Heart Study

Carrington, Melinda J., Chan, Yih-Kai, Calderone, Alicia, Scuffham, Paul A., Esterman, Adrian, Goldstein, Stan, and Stewart, Simon (2013) A multicenter, randomized trial of a nurse-led, home-based intervention for optimal secondary cardiac prevention suggests some benefits for men but not for women: the Young at Heart Study. Circulation: Cardiovascular Quality and Outcomes, 6 (4). pp. 379-389.

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Abstract

Background: We examined the impact of a prolonged secondary prevention program on recurrent hospitalization in cardiac patients with private health insurance.

Methods and Results: The Young at Heart multicenter, randomized, controlled trial compared usual postdischarge care (UC) with nurse-led, home-based intervention (HBI). The primary end point was rate of all-cause hospital stay (31.5 +/- 7.5 months follow-up). In total, 602 patients (aged 70 +/- 10 years, 72% men) were randomized to UC (n=296) or HBI (n=306, 96% received 1 home visit). Overall, 42 patients (7.0%) died, and 492 patients (82%) accumulated 2397 all-cause hospitalizations associated with 10258 hospital days costing >$17 million. There were minimal group differences (HBI versus UC) in the primary end point of all-cause hospital stay (5405 versus 4853 days; median [interquartile range], 0.08 [0.03-0.17] versus 0.07 [0.03-0.13]/patient per month). There were similar trends with respect to all hospitalizations (1197 versus 1200; P=0.802) and associated costs ($8.66 versus $8.58 million; P=0.375). At 2 years, however, more HBI versus UC (39% versus 27%; odds ratio, 1.67; 95% confidence interval, 1.15-2.41; P=0.007) patients were assessed as stable and optimally managed. For women, HBI outcomes were predominantly worse than UC outcomes. In men, HBI was associated with reduced risk of cardiovascular hospitalization (adjusted hazard ratio, 0.68; 95% confidence interval, 0.46-0.99; P=0.044) with less cardiovascular hospitalizations (192 versus 269; P=0.054) and costs ($2.49 versus $3.53 million; P=0.046).

Conclusions: HBI did not reduce recurrent all-cause hospitalization compared with UC in privately insured cardiac patients overall. However, it did convey some benefits in cardiac outcomes for men.

Clinical Trial Registration: Australian New Zealand Clinical Trials Registry Unique Identifier: 12608000014358.

Item ID: 37508
Item Type: Article (Research - C1)
ISSN: 1941-7705
Keywords: follow-up studies, heart diseases, prevention and control
Funders: BUPA Health Foundation
Date Deposited: 04 Feb 2015 07:41
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified @ 100%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 100%
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