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At-Home
Care may be an alternative to Hospital Care
for Elderly Patients with Chronic Heart
Failure
Newswise — Hospital-at-home care may be a
practical alternative to traditional
hospital inpatient care for patients with
acutely decompensated (suddenly worsening)
chronic heart failure, according to a report
in the September 28 issue of Archives of
Internal Medicine, one of the JAMA/Archives
journals.
Nearly 7 million Europeans and 5 million
North Americans are affected by chronic
heart failure, a progressive and disabling
syndrome, according to background
information in the article.
Hospitalization for chronic heart failure
for older patients has increased and occurs
in 2 percent to 3 percent of patients over
age 85 every year. In the United States,
decompensation (worsening) of chronic heart
failure leads to more than 1 million
hospital admissions per year and a 50
percent risk of subsequent hospitalization
within six months of discharge.
“Although the hospital is the standard venue
for providing acute medical care, it may be
hazardous for older persons, who commonly
experience iatrogenic illness [complications
due to treatment], functional decline and
other adverse events.”
Vittoria Tibaldi, M.D., Ph.D., and
colleagues at the University of Torino, San
Giovanni Battista Hospital, Torino, Italy,
compared the effectiveness of a
physician-led hospital-at-home service for
elderly patients with acute decompensation
of chronic heart failure with traditional
hospital inpatient care.
Patients age 75 or older with decompensation
of chronic heart failure were randomly
assigned to either a general medical ward
(53 patients) or to the Geriatric Home
Hospitalization Service (48 patients)
between April 2004 and April 2005.
The Geriatric Home Hospitalization Service
provided diagnostic and therapeutic
treatments by hospital health care
professionals in the home of the patient.
At six months, 15 percent of all patients
had died, with no significant differences
between the two groups.
“The number of subsequent hospital
admissions was not statistically different
in the two groups, but the mean [average]
time to first additional admission was
longer for the Geriatric Home
Hospitalization Service patients (84.3 days
vs. 69.8 days).
"Only
the Geriatric Home Hospitalization Service
patients experienced improvements in
depression, nutritional status and
quality-of-life scores,” the authors write.
“Recent trends in health care favor
alternatives to traditional acute care in
hospitals. These trends include advancement
in telehealth technologies and increased
demand for treatment at home,” the authors
conclude.
“Further development of hospital-at-home
care will require additional research and
dedicated resources to support
dissemination.”
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