Current treatment in hospital based outpatient heart failure clinics: The Canadian CHF Clinics Network initial experience

Abstract:

Background: Chronic heart failure (CHF) presents an
increasing clinical burden to both patients and physicians.
Changes in clinical practice may not occur rapidly following
advances in treatment described in large clinical trials. The
Canadian CHF Clinics Network has been established in 11 initial
centres across Canada to improve the current management of 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
physician, nurses, and patients, a national computerized
database, and a strategy of education to enhance CHF treatment in
the community have been developed.
Results: Selected mean baseline characteristics of the
883 patients entered into the database over the first 12 months
(1999) were: age 64 years; male 72%; ischemic 62%; NYHA Class I
13.0%, II 34.8%, III 40.8%, IV 11.4%; LVEF 24%, LVEF > 45%
5.9%; Minnesota HF score 46; history of hypertension 27%;
dyslipidaemia 28%; diabetes 21%; current smoker 8%; renal
dysfunction 11%; atrial fibrillation 16%. Treatment profiles for
drug use were: ACE-I 76%; AT1 blocker 9%; beta blockers 5%;
furosemide 81%; spironolactone 16%; digoxin 60%; long acting
nitrates 26%; antiplatelet 43%; warfarin 37%; amlodipine 11%;
amiodarone 19%; statins 38%; The frequency of change in
management as the result of physician-patient interaction
resulted in: medication change 46%, blood work 63%, ECG 44%;
education regarding medication 46%, CHF 42%, fluid/salt 42%,
monitor home weight 42%, exercise 27%. The man daily doses of
drugs were captopril 102mg, enalapril 22mg, lisinopril 34mg,
carvedilol 22mg, metoprolol 80mg, spironolactone 35mg, furosemide
87mg.
Conclusion: Specialised CHF clinics, representing a cross
section of communities across Canada, show a high utilization of
proven therapies from clinical trials at the time of first entry
into the database. This is combined with emphasis on patient
education. Further clinics are currently being added to the
Network. Prospective assessment is ongoing to assess the role of
such specialised clinics to further improve patient management,
outcomes, satisfaction, and cost effectiveness.