Hospital-at-Home care for acute heart failure: Feasibility and safety pilot.

Abstract

Introduction: Heart failure (HF) is a global health issue, imposing a significant burden on healthcare systems. Deventer Hospital recently introduced DZThuis, a hybrid Hospital-at-Home care model for patients with acute decompensated heart failure (ADHF). Patients receive treatment with intravenous diuretics at home when possible and in hospital when necessary. This pilot study evaluated the feasibility of DZThuis and compared outcomes with conventional in-hospital care to assess safety.

Methods: This retrospective, single-centre cohort study compared 47 DZThuis patients (July 2022-November 2023) with 60 in-hospital ADHF patients admitted between August 2021 and July 2022. Kaplan-Meier curves and log-rank tests were used to analyse mortality and time to the composite endpoint of mortality or HF readmission. Secondary endpoints included total treatment duration, renal function, and complications.

Results: No significant differences were found in mortality (p = 0.987) or time to the composite endpoint (p = 0.745). Treatment duration did not significantly differ (DZThuis: 11.3 ± 8.4 days vs in-hospital: 8.8 ± 4.9 days; p = 0.068). Complication rates were comparable. Five DZThuis patients transitioned to in-hospital care, in line with the hybrid model's design.

Conclusion: Despite a higher prevalence of comorbidities, DZThuis demonstrated outcomes comparable with traditional in-hospital care for ADHF patients and proved to be a feasible and safe model. Further long-term research in larger cohorts is needed to confirm safety and efficacy, with a particular focus on the impact of Hospital-at-Home care on quality of life and patient satisfaction.