Chronic Heart Failure Patients: Dealing With High Risk or Low Risk - Research Paper Example

 The article selected for critical appraisal is "Effects of a multidisciplinary, home-based intervention on planned readmissions and survival among patients with chronic congestive heart failure: a randomized controlled study" by Stewart, S., Marley, J.E., & Horowitz, J.D., published in 1999 in Lancet, 354, 1077-83. The purpose of this study by Stewart and colleagues (1999) was to measure the effects of a multidisciplinary home based intervention on planned readmissions and survival among patients with chronic congestive heart failure (CHF). The hypothesis (null) in this study was that there would be no difference in the frequency of unplanned readmission plus out-of hospital deaths, during a minimum of 6 months of follow-up, among patients with chronic CHF discharged home after acute admission between those exposed and not exposed to a CHF-specific, multidisciplinary, home based intervention in addition to usual care. The Study This study included 200 patients from the inpatient department in a tertiary care hospital under the care of a cardiologist. To arrive at this study number, the researchers screened initially 4055 cardiology inpatients and narrowed down to 285 patients and finally to 200 patients after consent. The study was approved by ethics committee and consent of all participants also was taken. The inclusion and exclusion criteria were appropriate for the study type and purpose. This is a good-size study. Actually the researchers’ previous study had pointed that 90 patients in each group would be required to detect a 20% difference in the end point (Stewart, 1998). This study included 100 in each group. In this study, the patients were randomized. Randomization was concealed. Randomization was initiated after measuring mental acuity, function status and extent of co-morbidity. 2 groups were formed. One group were subjected to usual care alone and the other to multidisciplinary home based intervention along with usual care. For both the groups the discharge planning was the same. This was adopted because; the authors postulated that home visits represent the most effective component of this type of intervention. The investigator was unaware of the demographic and clinical profile and was allocated the individual via phone by a separate unit. Equal size of groups and distribution of patients was done through a computer generated protocol. Patients were analyzed in the groups to which they were randomized. The demography profile included sex, mean age, whether living alone, primary language and number of years of formal education ( Read More