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Effect of extended follow‐up in a specialized heart failure clinic on adherence to guideline recommended therapy: NorthStar Adherence Study
Author(s) -
Schou Morten,
Gislason Gunnar,
Videbaek Lars,
Kober Lars,
Tuxen Christian,
TorpPedersen Christian,
Hildebrandt Per R.,
Gustafsson Finn
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.176
Subject(s) - medicine , heart failure , hazard ratio , guideline , outpatient clinic , confidence interval , randomized controlled trial , physical therapy , pathology
Aims The optimal duration of a public heart failure ( HF ) clinic programme is unknown. This substudy of the NT‐proBNP stratified follow‐up in outpatient heart failure clinics ( NorthStar ) trial was designed to evaluate the effect of extended follow‐up in an outpatient HF clinic on long‐term adherence to guideline‐based therapy. Methods and results Patients with HF with reduced EF on optimal medical therapy ( n = 921) were randomized to either extended follow‐up in the HF clinic ( n = 461) or discharge to primary care ( n = 460) and followed for a median of 4.1 years (range: 13 months to 6.1 years). The effect of the HF clinic intervention on treatment adherence (time to at least a 90 day break in treatment) was estimated by drug dispensing from pharmacies of an ACE inhibitor/ ARB , beta‐blocker ( BB ), or mineralocorticoid receptor antagonist ( MRA ). Median age was 69 years, 25% were females, LVEF was 30%, and 90% were in NYHA class II–III . The HF clinic intervention did not reduce time to a 90 day break in treatment with either an ACE inhibitor/ ARB [hazard ratio ( HR ) 0.82, 95% confidence interval ( CI ) 0.34–1.97, P = 0.650], a BB ( HR 1.09, 95% CI 0.53–2.66, P = 0.820), or an MRA ( HR 1.30, 95% CI 0.85–2.00, P = 0.238). Conclusions Extended follow‐up in an outpatient HF clinic did not improve long‐term adherence to guideline‐based therapy, and adherence did not deteriorate when follow‐up was shifted from the HF clinic to primary care.