Effect of Extended Follow-Up in a Specialized Heart Failure Clinic on Adherence to Guideline Recommended Therapy: NorthStar Adherence Study
Key result
Extended follow-up in an outpatient heart failure clinic did not reduce time to a 90-day treatment break for ACEi/ARBs (HR 0.82; 95% CI 0.34-1.97; P=0.650) compared to primary care.
Why the study?
Does extended follow-up in an outpatient HF clinic improve long-term adherence to guideline-based therapy in patients with HFrEF?
Population
921 patients with heart failure with reduced ejection fraction on optimal medical therapy, median age 69…
Comparison
Extended follow-up in an outpatient heart… vs Discharge to primary care
Design
RCT, Randomized
Follow-up
median 4.1 years (range: 13 months to 6.1 years)
Authors
Discussion
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Member takes
Implication
Supports discharge to primary care after HFrEF stabilization; confirms no long-term adherence benefit from extended HF clinic follow-up.
Study Design
Type
RCT (n=921)
Structured PICO
Does extended follow-up in an outpatient HF clinic improve long-term adherence to guideline-based therapy in patients with HFrEF?
P
Population
921 patients with heart failure with reduced ejection fraction (HFrEF) on optimal medical therapy, median age 69 years, 25% female, LVEF 30%, and 90% in NYHA class II-III.
I
Intervention
Extended follow-up in an outpatient heart failure (HF) clinic
C
Comparator
Discharge to primary care
O
Outcome
Treatment adherence (time to at least a 90 day break in treatment) estimated by drug dispensing from pharmacies of an ACE inhibitor/ARB, beta-blocker (BB), or mineralocorticoid receptor antagonist (MRA)
Main Result
Effect estimate: HR 0.82 (95% CI 0.34-1.97)
p-value: p=0.650
Extended follow-up in a specialized outpatient heart failure clinic does not improve long-term adherence to guideline-directed medical therapy compared to discharge to primary care.
Cite This Study
Schou et al. (2014) conducted an RCT in Heart failure with reduced ejection fraction (n=921). Extended follow-up in an outpatient heart failure clinic vs. Discharge to primary care was evaluated on Time to at least a 90 day break in treatment with an ACE inhibitor/ARB, beta-blocker, or MRA (HR 0.82, 95% CI 0.34-1.97, p=0.650). Extended follow-up in an outpatient heart failure clinic did not reduce time to a 90-day treatment break for ACEi/ARBs (HR 0.82; 95% CI 0.34-1.97; P=0.650) compared to primary care.