The Centre of Research Excellence (CRE) to Reduce Inequality in Heart Disease focuses on improving the heart health and outcomes of groups and communities i.e. Regional Australians, Indigenous Australians and International Health
Research Stream: Regional Australians
Which Heart failure Intervention is most Cost effective in reducing Hospital care (WHICH?) II Trial: A multicentre, randomised trial of standard versus intensified management of metropolitan and regional-dwelling patients with heart failure.
Which Heart failure Intervention is most Cost effective in reducing Hospital stay (WHICH?) II Trial
Australian New Zealand Clinical Trials Registry number: 12613000921785 (http://www.anzctr.org.au)
National Health and Medical Research Council Project Grant (2013 - 2016) number 1049133
Chronic heart failure management programs (CHF-MPs) are now the gold-standard to cost-effectively care for thousands of Australians hospitalised with CHF each year. In the original WHICH? Trial we demonstrated that home-based management is most cost-effective in reducing hospital stay in CHF. However, this trial was confined to metropolitan dwelling individuals only and applied a “one size fits all” approach. The subsequent Which Heart failure Intervention is most cost-effective in reducing Hospital stay (WHICH?) II Trial, a multicentre, randomised study, will determine if more intensive care (via home visits and remote care contacts) further improves poor outcomes in CHF. It will, therefore, test a more individualised approach to post-discharge CHF management whilst examining the overall benefits of structured telephone support supplemented by home visits to those individuals living in regional Australia.
Although the overall evidence in favour of CHF-MPs to reduce readmission rates and prolong survival in high risk individuals discharged from hospital with CHF is now well established, there is still a need to undertake appropriately powered, randomised trials to determine the most cost-effective and consumer friendly components of care of CHF-MPs.
In the WHICH? II Trial we aim to:
The Which Heart failure Intervention is most Cost-effective in reducing Hospital stay (WHICH?) II Trial will test the hypothesis that: in typically older patients hospitalised with CHF and discharged to home, a more intense, nurse-led, post-discharge, multidisciplinary, CHF-MP incorporating outreach home-based intervention enhanced by structured telephone support (INT-CHF-MP) specifically targeting those at risk of recurrent (and costly) hospital stay will be superior to a standard form of CHFMP (S-CHF-MP) in reducing the total cost of health care (15% or more) during 18 month follow-up.
The WHICH? II Trial is a multicentre, randomised controlled trial, registered with the Australian New Zealand Clinical Trials Registry. It will conform to the principles outlined in the Declaration of Helsinki and to the CONSORT guidelines for a pragmatic study comparing the efficacy of two non-pharmacological health interventions.
The primary end-point of the WHICH? II Trial is the total cost of health care (calculated as cost/day to adjust for potential variance in survival) during 18 month follow-up.
Secondary endpoints include rate of hospitalisation (all-cause, CVD and CHF-specific), all-cause mortality, event-free survival from death or hospitalisation, generic (EQ-5D-5L) and CHF-specific (Kansas City Cardiomyopathy Questionnaire) changes in quality of life from baseline, and uptake of gold-standard therapy (including prescribed doses of angiotensin converting enzyme [ACE] inhibitors and beta blockers) assessed at 12 months post index hospital discharge.
This study is recruiting in 2013