Effect of extended follow-up in a specialized heart failure clinic on adherence to guideline recommended therapy: NorthStar Adherence Study

Morten Schou, Gunnar Gislason, Lars Videbaek, Lars Kober, Christian Tuxen, Christian Torp-Pedersen, Per R Hildebrandt, Finn Gustafsson, NorthStar Investigators

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

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.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Heart Failure
Vol/bind16
Udgave nummer11
Sider (fra-til)1249-55
ISSN1388-9842
DOI
StatusUdgivet - nov. 2014

Fingeraftryk

Guideline Adherence
Outpatients
Confidence Intervals
Primary Health Care
Pharmacies

Citer dette

Schou, Morten ; Gislason, Gunnar ; Videbaek, Lars ; Kober, Lars ; Tuxen, Christian ; Torp-Pedersen, Christian ; Hildebrandt, Per R ; Gustafsson, Finn ; NorthStar Investigators. / Effect of extended follow-up in a specialized heart failure clinic on adherence to guideline recommended therapy : NorthStar Adherence Study. I: European Journal of Heart Failure. 2014 ; Bind 16, Nr. 11. s. 1249-55.
@article{ac452fe449ef47cc91d1ae4684cb1dca,
title = "Effect of extended follow-up in a specialized heart failure clinic on adherence to guideline recommended therapy: NorthStar Adherence Study",
abstract = "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.",
author = "Morten Schou and Gunnar Gislason and Lars Videbaek and Lars Kober and Christian Tuxen and Christian Torp-Pedersen and Hildebrandt, {Per R} and Finn Gustafsson and {NorthStar Investigators}",
note = "{\circledC} 2014 The Authors. European Journal of Heart Failure {\circledC} 2014 European Society of Cardiology.",
year = "2014",
month = "11",
doi = "10.1002/ejhf.176",
language = "English",
volume = "16",
pages = "1249--55",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
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number = "11",

}

Schou, M, Gislason, G, Videbaek, L, Kober, L, Tuxen, C, Torp-Pedersen, C, Hildebrandt, PR, Gustafsson, F & NorthStar Investigators 2014, 'Effect of extended follow-up in a specialized heart failure clinic on adherence to guideline recommended therapy: NorthStar Adherence Study', European Journal of Heart Failure, bind 16, nr. 11, s. 1249-55. https://doi.org/10.1002/ejhf.176

Effect of extended follow-up in a specialized heart failure clinic on adherence to guideline recommended therapy : NorthStar Adherence Study. / Schou, Morten; Gislason, Gunnar; Videbaek, Lars; Kober, Lars; Tuxen, Christian; Torp-Pedersen, Christian; Hildebrandt, Per R; Gustafsson, Finn; NorthStar Investigators.

I: European Journal of Heart Failure, Bind 16, Nr. 11, 11.2014, s. 1249-55.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Effect of extended follow-up in a specialized heart failure clinic on adherence to guideline recommended therapy

T2 - NorthStar Adherence Study

AU - Schou, Morten

AU - Gislason, Gunnar

AU - Videbaek, Lars

AU - Kober, Lars

AU - Tuxen, Christian

AU - Torp-Pedersen, Christian

AU - Hildebrandt, Per R

AU - Gustafsson, Finn

AU - NorthStar Investigators

N1 - © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

PY - 2014/11

Y1 - 2014/11

N2 - 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.

AB - 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.

U2 - 10.1002/ejhf.176

DO - 10.1002/ejhf.176

M3 - Journal article

C2 - 25311554

VL - 16

SP - 1249

EP - 1255

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 11

ER -