Post-discharge home-based support for older cardiac patients: a randomised controlled trial

• Published in: Age and ageing Vol. 34; no. 4; pp. 338 - 343
• Main Authors: Sinclair, Alan J., Conroy, Simon P., Davies, Michael, Bayer, Antony J.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.07.2005; Oxford Publishing Limited (England)
• Subjects: Age Factors; Aged; cardiac rehabilitation; Cardiology; Case studies; Clinical trials; Elderly; elderly people; Health aspects; Heart attack; Heart attacks; Home Care Services; Home health care; Humans; ischaemic heart disease; Ischemia; myocardial infarction; Myocardial Infarction - rehabilitation; Older people; Patient admissions; Patient Discharge; Prospective Studies; Single-Blind Method
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afi116

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.