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A Prospective Randomized Controlled Trial

Vittoria Tibaldi, MD, PhD; Gianluca Isaia, MD; Carla Scarafiotti, MD; Federico Gariglio, MD; Mauro Zanocchi, MD; Mario Bo, MD, PhD; Serena Bergerone, MD; Nicoletta Aimonino Ricauda, MD

Arch Intern Med. 2009;169(17):1569-1575.

Background  Although the hospital is the standard venue for short-term medical care, it may be hazardous for older persons. This study was performed to evaluate the feasibility and effectiveness of a physician-led hospital-at-home service for selected elderly patients with acute decompensation of chronic heart failure (CHF).

Methods  Prospective, single-blind, randomized controlled trial with 6-month follow-up for patients 75 years or older admitted to the hospital from April 1, 2004, through April 31, 2005, for acute decompensation of CHF. Patients were randomly assigned to the general medical ward (n = 53) or to the Geriatric Home Hospitalization Service (GHHS; n = 48). The GHHS provides diagnostic and therapeutic treatments by hospital health care professionals in the home of the patient.

Results  Patient mortality at 6 months was 15% in the total sample, without significant differences between the 2 settings of care. The number of subsequent hospital admissions was not statistically different in the 2 groups, but the mean (SD) time to first additional admission was longer for the GHHS patients (84.3 [22.2] days vs 69.8 [36.2] days, P = .02). Only the GHHS patients experienced improvements in depression, nutritional status, and quality-of-life scores.

Conclusions  Substitutive hospital-at-home care is a viable alternative to traditional hospital inpatient care for elderly patients with acutely decompensated CHF. This type of care demonstrated clinical feasibility and efficacy in comparison with its alternative.

Trial Registration  clinicaltrials.gov Identifier: NCT00623571

Author Affiliations: Department of Medical and Surgical Disciplines, Geriatric Section (Drs Tibaldi, Isaia, Scarafiotti, Gariglio, Zanocchi, Bo, and Aimonino Ricauda), and Department of Cardiology (Dr Bergerone), University of Torino, San Giovanni Battista Hospital, Torino, Italy.

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