All DZThuis patients are initially assessed at the hospital’s Emergency Heart Care to determine whether they can receive treatment at home or if they require one or more nights in hospital before completing their treatment at home. If necessary, patients can be readmitted to hospital at a later stage during the treatment.

During DZThuis treatment, the patient is visited by a cardiac care unit (CCU) nurse in the morning, and the nurse remains available 24/7 by phone if needed. During the visit, a daily history is taken, a physical examination is performed, and blood is drawn to assess renal function. Laboratory results are available in the afternoon, at which point the nurse consults the cardiologist on duty. The cardiologist then adjusts medical treatment or discharges the patient from DZThuis.

Similar to standard in-hospital care, patients are followed up by the outpatient HF clinic within two weeks of discharge. General practitioners (GPs) are not involved in the treatment unless non-cardiac conditions are suspected.

The intervention group consists of consecutive acute decompensated heart failure (ADHF) patients admitted to DZThuis from the start of the programme in July 2022 to 1 November 2023. According to predetermined criteria, patients must have worsening heart failure requiring intravenous diuretics while remaining clinically stable enough to receive treatment at home. Therefore, patients receiving oxygen therapy or intravenous medication other than diuretics are not eligible for inclusion.

Patients with insufficient knowledge of the Dutch language, lack of internet access, or with dementia were excluded. Furthermore, patients must have adequate family support or reside in a care home to ensure daily physical care. For practical reasons, only patients living within 30 km of the hospital were eligible to participate in the programme.

If patients were accepted for DZThuis after 16.00 hrs, they spent the first night in hospital and began the programme the following morning. During the study period, up to four HF patients could participate in DZThuis simultaneously. If patients underwent multiple DZThuis treatments for separate episodes of ADHF, only their first treatment was included in the analysis.

As this is not a randomised trial, ADHF patients admitted to Deventer Hospital in the year before the start of DZThuis—between 1 August 2021 and 20 July 2022—served as the control group. Patients receiving intravenous medication other than diuretics or oxygen therapy were excluded, as these criteria would have rendered them ineligible for DZThuis.

Patients were discharged based on euvolaemia, as determined by the cardiologist’s clinical assessment in conjunction with renal function and urea levels.

The primary outcomes of this study were time to all-cause mortality and time to the composite endpoint of all-cause mortality or a HF-related readmission. Follow-up was completed on 1 February 2024, ensuring a minimum of 3 months survival data for all patients. Secondary endpoints were total duration of treatment, renal function, complications (infections, delirium, or falls), changes in weight, doses of furosemide, and rates of mortality or reaching the composite endpoint at 30 days and 3 months. It was our intention to analyse quality-of-life data using the Minnesota Living with Heart Failure Questionnaire and RAND-36 questionnaire but this was not possible due to incomplete data collection and high mortality rates.

Descriptive statistics were used to summarise baseline characteristics for both groups, and Pearson’s Chi-square tests and Fisher’s exact tests were utilised to compare them. Unpaired T‑tests were used for normally distributed data, and Mann-Whitney U tests for non-normally distributed data. Kaplan-Meier curves and log-rank tests were used to visualise and compare the primary endpoints. All statistical tests were two-tailed, with a significance level of p < 0.05 and were performed in IBM SPSS version 28.0.1.0.

This study was granted approval by the local Medical Ethics Assessment Committee in Zwolle and the Review Board of the Deventer Hospital. The METC committee confirmed that the Medical Research Involving Human Subjects Act (WMO) does not apply.