Promoting Best Physicians 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 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: catopril 90 mg, enalapril 22 mg, lisinopril 30 mg, carvedilol 28 mg, metoprolol 75mg, 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.