Promoting Best Physician Practices: The Canadian CHF Clinics Network

Abstract:

Introduction: Heart failure presents an increasing
clinical burden to both patients and physicians. Changes in
clinical practice frequently lag behind 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 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.
Results: Selected mean characteristics of the 573
patients entered into the database over the first 6 months are:
age 60 years; male 73%; ischemic 27%; NYHA Class I 7.9%, II
29.1%, III 35.6%. IV 12.4%; LVEF 22%, LVEF > 45% 4.7%;
Minnesota HF score 44; history of hypertension 25%; dyslipidaemia
27%; diabetes 23%; current smoker 7%; renal dysfunction 10%;
atrial fibrillation 18%. Treatment profiles for drug use were:
ACE-I 83%; AT1 blocker 8%; beta blockers 49%; furosemide 88%;
digoxin 60%; long acting nitrates 29%; antiplatelet 37%; warfarin
37%; amlodipine 13%; amiodarone 15%; hypolipidemics 35%;
hypoglycaemics 22%. The frequency of change in management as the
result of physician-patient interaction resulted in: medication
change 34%, blood work 53%; ECG 43%; education regarding
medication 36%, CHF 32%. fluid/salt/weight 33%, exercise 27%, 43%
of patients were on both an ACE-I and a beta blocker, 7% were on
spironolactone. The mean daily doses of drugs were: captopril 90
mg, enalapril 22 mg, lisinopril 30 mg, carvedilol 28 mg,
metoprolol 75 mg, spironolactone 41 mg. furosemide 97 mg.
Conclusion: These data demonstrate that specialised CHF
clinics have high utilization of proven therapies in combination
with emphasis on patient education and can promote best physician
practices in a broad range of communities across a country.