The Canadian CHF clinics network: implementation and initial results

Abstract:

The Canadian CHF Clinics Network has been established in 11
initial centres across Canada to improve the current management
of chronic heart failure (CHF), to implement new proven therapies
in a timely manner, and to collaborate in innovative research
approaches to optimise patient management. By consensus, a manual
of CHF management for physicians, nurses, and patients, a
national computerized database, and a strategy of education to
enhance CHF treatment in the community have been developed.
In January 1999, 2 centres began to pilot the database in their
established CHF clinics and, in April 1999, all centres have
begun enrolling patients. Selected characteristics of the first
118 patients entered into the database are: 64±16 (sd)
years; 71% male; 57% ischemic; 3.4% NYHA Class I, 29.7% II, 48.3%
III, 18.6% IV; 13% LVEF >45%; 16.8 MD visits per patient in
last 12 months; Minnesota HF score 44±23; history of
hypertension 36%; dyslipidaemia 37%; diabetes 36%; current smoker
14%; renal dysfunction 12%; atrial fibrillation 20%; arthritis
15%; cancer 10%. Treatment profiles for drug use were: ACE-I 85%;
AT1 blocker 6%; beta blockers 42%; furosemide 82%; digoxin 58%;
long acting nitrates 35%; antiplatelet 53%; warfarin 31%;
amlodipine 25%; amiodarone 12%; hypolipidemics 44%;
hypoglycaemics 35%. The frequency of change in management as the
result of physician-patient interaction resulted in: medication
change 43%, blood work 54%; ECG 38%; education regarding
medication 76%, disease 61%, fluid/salt/weight 56%, exercise
36%.
These preliminary data provide a basis to assess intervention
and patient responses in normal clinical ambulatory practice
within a range of outpatient clinics across Canada. Ten to 15 new
clinics will be added this year and each clinic will receive
quarterly reports of their local clinic and aggregate national
data. The database is flexible to allow new research questions to
be asked and to provide proof of the impact of new treatment
approaches.