Changes in Heart Failure Drug Utilization 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. The first formal meeting of the Network
members was in July 1998 when, through consensus, a manual of CHF
management for physicians, nurses, and patients was developed. A
computerized database was designed and implemented in Jan 1999
and 883 patients were seen and had their data entered in the
first 12 months. These patients represent both new patients to
the clinic and some previously seen in the clinic but who were
being entered into the longitudinal database for the first
time.
Selected mean baseline characteristics of these patients were:
age 64 years; male 72%; ischemic aetiology 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 ramipril (27.1 vs 10.3%, p<0.0001), while all
ACE-I use remained constant (70.3%), and spironolactone (31.8 vs
5.0%, p<0.0001). Beta blocker use was 39.9% but showed a
nonsignificant increase to 44.7% (carvedilol 22.4%, metoprolol
20.6%). Furosemide and digoxin use remained unchanged at 69.4 vs
73.4% and 50.0 vs 50.5% respectively. The physician-patient
interaction resulted in a change of drug treatment in 46% of
encounters and education regarding medication in 46%, CHF 42%,
fluid/salt 42%, home weight monitoring 42%, and exercise 27%
respectively.
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. The clinics emphasized the importance of
patient education of their disease, their medications and early
warning signs of worsening heart failure. Assessment of clinical
outcomes is being prospectively captured within the Network
database. While national utilization of the same medications in
general medical practice over the same time period is not
available at this time, the data support the role of such clinics
in translating clinical trials into clinical practice.