Evaluation of a Community Health Service Center-Based Intervention Program for Managing Chronic Heart Failure

Abstract

Background: Although the role of primary care for the management of patients with chronic heart failure (CHF) has been highly recommended, structural in-volvement of primary care in heart failure (HF) man-agement programs is extremely limited.Aims: To examine the feasibility and applicability of two most recommended forms of care delivery mode, home visit and telephone support, for CHF management in the setting of community health ser-vice center (CHSC).Study Design: Prospective study.Methods: This study was conducted in two CHSCs in Beijing, China. Care delivery was led by trained gen-eral practitioners or community nurses via home visits in one CHSC and telephone support in the other. Data regarding the change in mortality and hospitalization rate during 12 months and self-care level at 6 months were prospectively collected and compared across the intervention groups.Results: A total of 329 patients were included, with 142 in the home visit group and 187 in the telephone sup-port group. Patients in both groups had frequent visits to CHSC (8.1±5.9 in the home visit and 7.7±4.1 in the telephone support group, p=0.45) during the follow-up period. Compared to the telephone support group, pa-tients in the home visit group showed a reduction in all-cause mortality (14.1% versus 20.3%, p=0.14), one or more hospitalizations due to any cause (33.8% ver-sus 44.2%, p=0.12) and one or more hospitalizations due to cardiac cause (17.6% versus 24.6%, p=0.13) in the home visit group. The absolute differences were 6.2% (95% CI: 1.9%, 14.3%), 8.4% (95% CI: 2.1%, 18.9%) and 7.3% (95% CI: 1.5%, 16.1%), respectively, although the results were not statistically significant. After 6 months of intervention, patients in both groups achieved marked improvement in self-care with refer-ence to their own baseline values.Conclusion: Although no statistical difference was ob-served between the two care delivery approaches re-garding the clinical outcomes of interest, given the high participation rates, the acceptable rate of adverse events, frequent CHSC visits and patients' preferences in the cur-rent study, it was concluded that CHSC might be the op-timal setting for delivering care to CHF patients in China.Keywords: Chronic heart failure, home visit, mortality