Home-Based Heart Failure Care Shows Comparable Safety to Continued Inpatient Care

An advanced medical care at home (AMCAH) program for patients hospitalized with heart failure (HF) produced comparable safety and quality outcomes after discharge compared with continued brick-and-mortar (BAM) hospitalization, according to a retrospective cohort study published in JAMA Network Open.¹

“Our study had numerous strengths, including a diverse patient population,” wrote the researchers of the study. ”We pursued both an intra- and inter-service area comparison and sensitivity analyses, supporting the robustness of our findings. We had a comprehensive list of variables, including socioeconomic factors, which likely has even greater relevance for AMCAH. Furthermore, we are 1 of the first studies to evaluate GDMT [guideline-directed medical therapy] utilization rigorously.”

Researchers at Kaiser Permanente Southern California (KPSC) analyzed adult patients hospitalized with a principal diagnosis of HF across 11 service areas between February 2023 and December 2024. The AMCAH program—standardized regionally in February 2023 following a staggered service-area rollout—provides mobile phlebotomy, intravenous medication administration, nursing visits, remote patient monitoring, virtual case management, and daily virtual physician rounding for patients enrolled from clinics, emergency departments, observation units, or inpatient settings.

No Significant Differences in Safety Outcomes

Using propensity score matching, researchers created 2 comparison cohorts: an intra–service area comparison of 307 matched pairs and an inter–service area comparison, akin to a stepped-wedge design, of 239 matched pairs. The primary outcome was a composite of all-cause care escalation, readmission, or mortality at 30 days.

In the intra–service area comparison, 73 composite events (24%) occurred in the AMCAH group compared with 80 events (26%) in the BAM group (OR, 0.89; 95% CI, 0.61-1.28), with similar trends across the individual components of care escalation, readmission, and mortality. Days alive and out of hospital (DAOH) were nearly identical between groups—28.2 days for AMCAH vs 28.3 days for BAM at 30 days. The inter-service area comparison showed a similar pattern, with 53 events (22%) in the AMCAH group vs 59 events (25%) in the BAM group. No significant differences emerged at 60 days in either comparison.

Guideline-Directed Therapy Held Steady at Home

A key focus of the study was whether guideline-directed medical therapy (GDMT)—covering renin-angiotensin-system inhibitors, β blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors—could be initiated and titrated in the home setting without compromising subsequent GDMT utilization. Mean GDMT scores at 30 days were comparable between groups (3.2 for AMCAH vs 3.1 for BAM on a 0-9 scale), and the pattern held at 60 days. Notably, GDMT utilization was similar or higher in the AMCAH group even before matching, suggesting treatment intensity was maintained following transition to home-based care.

The AMCAH group entered the program with a greater illness burden than the BAM group prior to matching, including a higher Elixhauser comorbidity score (9.2 vs 7.7) and, in the inter-service area cohort, more prior-year HF hospitalizations. The authors noted that their 30-day readmission rates (22%-24%) were higher than previously reported system-wide rates (18%), whereas escalation rates (5%-6%) were lower than prior reports (10%-16%), providing additional reassurance regarding the safety of enrolling patients with greater illness burden into AMCAH when eligibility is determined by clinicians. Program penetration remained modest, at 6% to 7% of eligible hospitalizations, which the authors attributed to factors including clinician and patient unfamiliarity with a newer program and ongoing operational scaling challenges.

The findings add to a small but growing body of comparative evidence for hospital-at-home models in HF. A retrospective analysis at Cleveland Clinic Florida comparing 194 patients enrolled in a hospital-at-home program with 201 treated in a traditional hospital setting between April 2023 and August 2024 similarly reported favorable safety and clinical outcomes with the model for HF management, with roughly 90% of eligible screened patients opting for home-based care.²

Managed Care Implications

For managed care organizations and integrated delivery systems, these findings suggest clinician-determined eligibility can support safe implementation of hospital-at-home programs for appropriately selected patients without compromising short-term outcomes or GDMT optimization. Conducted within a value-based, capitated health system without encounter-level revenue incentives, the study also highlights how integrated delivery models may facilitate expansion of hospital-at-home services while maintaining comparable outcomes. Health plans and systems considering AMCAH-type programs may benefit from pairing expansion with careful patient selection, clinician training, and operational support rather than relying solely on protocol-driven eligibility criteria.

The modest 6% to 7% penetration rate also points to a substantial gap between clinical readiness and operational uptake, indicating that payers and health systems evaluating similar programs may need to invest in clinician and patient education, staffing, and workflow support to realize the model's potential operational and capacity benefits, particularly as the regulatory future of hospital-at-home programs continues to evolve. The authors also cautioned that findings from Kaiser Permanente's integrated, value-based care model may not be directly generalizable to other health systems, particularly those operating under different reimbursement structures or regulatory environments.¹

Overall, the findings support hospital-at-home as a reasonable alternative for carefully selected patients with acute heart failure while reinforcing the importance of clinician-directed patient selection rather than suggesting universal equivalence with continued inpatient hospitalization.

“In this cohort study among patients hospitalized with HF, no differences in all-cause readmissions, mortality, DAOH, or GDMT scores were seen at 30 or 60 days after discharge among individuals who received AMCAH vs those who underwent continued BAM hospitalization, highlighting the safety and quality of an AMCAH program with clinician-determined eligibility,” wrote the researchers.

References

1. Huang C, Huynh DN, Han B, et al. Advanced medical care at home among patients with acute heart failure. JAMA Netw Open. 2026;9(7):e2623510. doi:10.1001/jamanetworkopen.2026.23510
2. Hospital-at-home care model shown safe and effective in heart failure management. Cleveland Clinic. December 26, 2024. Accessed July 15, 2026. https://consultqd.clevelandclinic.org/hospital-at-home-care-model-shown-safe-and-effective-in-heart-failure-management