Bosman Jesper B, Jager Florine J P, Badings Erik A, van Wijngaarden Jan, Jansen Klomp Wouter W
Department of Cardiology, Deventer Hospital, Deventer, The Netherlands.
Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands.
Neth Heart J. 2025 May;33(5):157-162. doi: 10.1007/s12471-025-01949-0. Epub 2025 Mar 25.
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.
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.
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.
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.
心力衰竭（HF）是一个全球性的健康问题，给医疗系统带来了沉重负担。德文特医院最近推出了DZThuis，这是一种针对急性失代偿性心力衰竭（ADHF）患者的居家与医院相结合的护理模式。患者尽可能在家中接受静脉利尿剂治疗，必要时住院治疗。这项前瞻性研究评估了DZThuis的可行性，并将结果与传统住院护理进行比较以评估安全性。
这项回顾性单中心队列研究将47例DZThuis患者（2022年7月至2023年11月）与2021年8月至2022年7月期间收治的60例住院ADHF患者进行了比较。采用Kaplan-Meier曲线和对数秩检验分析死亡率以及至死亡或心力衰竭再入院复合终点的时间。次要终点包括总治疗时长、肾功能和并发症。
在死亡率（p = 0.987）或至复合终点的时间（p = 0.745）方面未发现显著差异。治疗时长无显著差异（DZThuis组：11.3 ± 8.4天 vs 住院组：8.8 ± 4.9天；p = 0.068）。并发症发生率相当。5例DZThuis患者转为住院治疗，这与混合模式的设计相符。
尽管合并症患病率较高，但DZThuis对ADHF患者的治疗结果与传统住院护理相当，且被证明是一种可行且安全的模式。需要在更大队列中进行进一步的长期研究以确认安全性和有效性，尤其要关注居家医院护理对生活质量和患者满意度的影响。
