Changes in drug utilization in specialised heart failure clinics during 1999: the Canadian CHF clinics network experience

Abstract:

The Canadian CHF Clinics Network was established to improve
the current management of CHF, to implement new proven strategies
in a timely manner, and to monitor treatment trends in 11 initial
centres across Canada. A longitudinal computerized database was
designed and implemented in Jan 1999 and data from 883 patients
have been entered in the first 12 months.
Selected mean baseline characteristics of these patients were:
age 64 years; male 72%; ischemic 62%; NYHA Class I 13.0%, II
34.8%, III 40.8%, IV 11.4%; LVEF 24%. Drug utilization changed
from the first to the last quarter of 1999 with an increase in
spironolactone (31.8 vs 5.0%, P<0.0001) and an increase in
ramipril (27.1 vs 10.3%, P<0.0001), while all ACE-I use
remained constant (70.3%). Beta blocker use showed a
nonsignificant increase from 39.9% to 44.7% (carvedilol 22.4%,
metoprolol 20.6%). Furosemide and digoxin use remained unchanged
at 73 and 55% respectively. The physician-patient interaction
resulted in a change of drug treatment in 46% of encounters and
education regarding medication in 46% of encounters.
Several important major clinical trials were presented or
published in 1998/99 including HOPE, RALES, CIBIS-2, MERIT-HF,
and BEST. The impact of these trials was rapidly assimilated into
clinical practice within these specialised heart failure clinics.
The clinics also emphasised the importance of patient education
of their disease and their medications. Assessment of clinical
outcomes is being prospectively captured within the Network
database. While national utilisation of the same medications in
general medical practice is not available at this time, the data
support the role of such clinics in translating clinical trials
into clinical practice.