Research Paper |
Post-discharge home-based support for older cardiac patients: a randomised controlled trial
1 Successful Ageing Programme, Section of Geriatric Medicine and Gerontology, Centre for Health Services Studies, Warwick Business School, The University of Warwick, Coventry CV4 7AL, UK
2 Ageing and Disability Research Unit, B98, Medical School, Queen’s Medical Centre, Nottingham NG7 2UH, UK
3 Department of Cardiology, Selly Oak Hospital, Birmingham B29 6JD, UK
4 Department of Geriatric Medicine, Wales College of Medicine, Cardiff University, Llandough Hospital, Penarth CF64 2XX, UK
Address correspondence to: A. J. Sinclair. Fax: (+44) 24 7652 4963. Email: alan.sinclair{at}wbs.ac.uk
Abstract
Background: hospital and exercise-based cardiac rehabilitation programmes do not suit many older patients and home-based rehabilitation may be more effective.
Objective: to evaluate a home-based intervention for patients aged 65 years or over discharged home from hospital after emergency admission for suspected myocardial infarction.
Design: a single-blind randomised controlled trial comparing home-based intervention by a nurse with usual care.
Subjects: patients aged 65 years or over discharged home after hospitalisation with suspected myocardial infarction (n= 324).
Intervention: home-based intervention (n = 163) consisted of home visits at 1–2 and 6–8 weeks after hospital discharge by a nurse who encouraged compliance with and knowledge of their treatment regimen, offered support and guidance about resuming daily activities, and involved other community services as appropriate.
Measurements: up to 100 days after admission, data were collected on deaths, hospital readmissions and use of outpatient services. Survivors were sent a postal questionnaire to assess activities of daily living and quality of life.
Results: at 100 day follow-up there was no difference in deaths, activities of daily living or overall quality of life, but those in the intervention group scored significantly better on the confidence and self-esteem subsections. The intervention group had fewer hospital readmissions (35 versus 51, relative risk 0.68, 95% CI 0.47–0.98, P < 0.05) and fewer days of hospitalisation after initial discharge (mean difference –1.7, 95% CI –2.09 to –1.31, P < 0.05). A total of 42/43 individuals in the intervention group had resumed driving at follow-up, compared with 32/43 in the usual care group (observed difference between proportions 23%, 95% CI 9–37%, P < 0.05).
Conclusion: amongst older patients discharged home after hospitalisation for suspected myocardial infarction, home-based nurse intervention may improve confidence and self-esteem, and reduce early hospital readmissions.
Keywords: elderly people, myocardial infarction, ischaemic heart disease, cardiac rehabilitation
Received August 20, 2004; Revision received December 5, 2004. accepted in revised form December 5, 2004.