Current treatment in hospital heart failure clinics: the Canadian CHF clinics network initial experience

Abstract:

Heart failure presents an increasing clinical burden to both
patients and physicians. Changes in clinical practice may not be
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 chronic heart failure (CHF), to implement
new proven strategies 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.
Results: Selected mean characteristics of the 883
patients entered in the database over the first 12 months are:
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 52%; furosemide 81%;
spironolactone 16%; digoxin 60%; long acting nitrates 26%;
antiplatelet 43%; warfarin 37%; amlodipine 11%; amiodarone 19%;
statins 28%. The frequency of change in management as the result
of physician-patient interaction resulted in: medication change
46%, blood work 63%; ECG 49%; education regarding medication 46%,
CHF 42%, fluid/salt 42%, monitor home weight 42%, exercise 27%.
The mean daily doses of drugs were captopril 102mg, enalapril
22mg, lisinopril 34mg, carvedilol 22mg, metoprolol 80mg,
spironolactone 35mg, furosemide 87mg.
Conclusions: Specialised CHF clinics, representing a
cross section of communities across Canada, demonstrate a high
utilization of therapies proven effective in clinical trials.
This is combined with emphasis on patient education. The role of
such specialised clinics requires ongoing assessment of patient
outcomes, satisfaction, and cost effectiveness.