Hospital-at-home care may be a practical alternative to traditional hospital inpatient care for patients with suddenly worsening chronic heart failure, according to a new study.

Nearly 7 million Europeans and 5 million North Americans are affected by chronic heart failure, a progressive and disabling syndrome. Hospitalization for chronic heart failure has increased and occurs in 2 percent to 3 percent of patients over age 85 every year. In the United States, 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," study authors are quoted as saying.

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 worsening of chronic heart failure with traditional hospital inpatient care. Between April 2004 and April 2005, patients age 75 or older with worsening of chronic heart failure were randomly assigned to either a general medical ward (53 patients) or to the Geriatric Home Hospitalization Service (48 patients). 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 average time to first additional admission was longer for the Geriatric Home Hospitalization Service patients (84.3 days vs. 69.8 days)," study authors wrote. "Only the Geriatric Home Hospitalization Service patients experienced improvements in depression, nutritional status and quality-of-life scores."

"Recent trends in health care favor alternatives to traditional acute care in hospitals," the authors concluded. "These trends include advancement in telehealth technologies and increased demand for treatment at home. Further development of hospital-at-home care will require additional research and dedicated resources to support dissemination."

SOURCE: Archives of Internal Medicine, September 28, 2009