Collaborative palliative care for advanced heart failure: outcomes and costs from the ‘Better Together’ pilot study
- 1Health Sciences, University of York, York, UK
- 2Centre for Health Economics, University of York, York, UK
- Correspondence to Jill F Pattenden, Health Sciences, University of York, Seebohm Rowntree Building, Area 4, Alcuin College, Heslington, York YO10 5DD, UK;
Contributors JFP was the principal investigator and AM the health economist. RJPL supervised the study. All three authors drafted and revised the manuscript and approved the final version.
Background Patients with heart failure often receive little supportive or palliative care. ‘Better Together’ was a 2-year pilot study of a palliative care service for patients with advanced congestive heart failure (CHF).
Objective To determine if the intervention made it more likely that patients would be cared for and die in their place of choice, and to investigate its cost-effectiveness.
Methods This pragmatic non-randomised pilot evaluation was set in two English primary care trusts (Bradford and Poole). Prospective patient-level data on outcomes and costs were compared with data from a historical control group of clinically comparable patients. Outcomes included death in preferred place of care (available only for the intervention group) and ‘hospital admissions averted’. Costs included medical procedures, inpatient care and the direct cost of providing the intervention.
Results 99 patients were referred. Median survival from referral was 48 days in Bradford and 31 days in Poole. Most patients who died did so in their preferred place of death (Bradford 70%, Poole 77%). An estimated 14 and 18 hospital admissions for heart failure were averted in Bradford and Poole, respectively. The average cost-per-heart failure admission averted was £1529 in Bradford, but the intervention was cost saving in Poole. However, there was considerable uncertainty around these cost-effectiveness estimates.
Conclusions This pilot study provides tentative evidence that a collaborative home-based palliative care service for patients with advanced CHF may increase the likelihood of death in place of choice and reduce inpatient admissions. These findings require confirmation using a more robust methodological framework.
Funding The British Heart Foundation (BHF) and Marie Curie Cancer Care funded the Better Together pilot study and this research. The sponsors had no involvement in producing this manuscript but the BHF approved the final paper.
Competing interests JFP was fully funded by the British Heart Foundation (BHF) during the course of the study. RJPL received two days of funding per week from the BHF for his role as director of the BHF Care and Education research group.
Ethics approval Leeds (West) Research Ethics Committee and the research governance departments of the participating hospital trusts approved this study.
Provenance and peer review Not commissioned; externally peer reviewed.
- Received 23 March 2012.
- Accepted 2 July 2012.
- Published Online First 4 September 2012
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