Feasibility and Efficacy of a Hybrid Post-Discharge Service for Patients with Acute Heart Failure-the Tyrolean Model

Heart failure is the most common reason for hospital admission in people aged over 65 years. Re-admission rates within 6 months of discharge from hospital are up to 50 %. Home-based interventions reduce the frequency of unplanned re-admissions in chronic heart failure patients. The aim of this pilot study was to show feasibility, efficacy and the impact on health care costs of a hybrid post-discharge service for patients with acute heart failure tailored to the existing infrastructure of the greater Innsbruck area. We prospectively studied the 6-month effects of a comprehensive post-discharge management comprising home visits by specialized heart failure nurses based on a heart failure clinic in a cohort of patients with acute heart failure. 17 patients treated for acute heart failure at the Medical University of Innsbruck between July and September 2003 were included into the study. Patients were randomly allocated to either an intervention group (n = 8) or usual care (n = 9). Readmission rates within 6 months were 37 % in the intervention group vs. 78 % in the control group (p < 0.05). There was a trend towards extension of time until readmission in the intervention group as compared to the control group (127 +/- 24 vs. 84 +/- 23 days; p > 0.05). Furthermore, there was a trend towards improved neurohumoral therapy in the intervention group. We estimated that the reduction of the re-admission rate in the intervention group accounts for a shortening of health care costs of about (sic) 2266 per patient year. The application of this hybrid post-discharge model to the county of Tyrol may allow for savings in health care costs of about (sic)1,172,820 per year. This pilot study shows the feasibility of a hybrid post-discharge service for elderly patients with acute heart failure including the fulfilment of particular legal obligations of the Austrian law. The comprehensive patient management is associated with a reduction in re-admission rate and savings in health care costs.