Long‐term follow‐up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH‐2 study. (10th October 2014) - Luttik, Marie Louise A.
Abstract Aims It has been suggested that home‐based heart failure (HF) management in primary care may be an alternative to clinic‐based management in HF patients. However, little is known about adherence to HF guidelines and adherence to the medication regimen in these home‐based programmes. The aim of the current study was to determine whether long‐term follow‐up and treatment in primary care is equally effective as follow‐up at a specialized HF clinic in terms of guideline adherence and patient adherence, in HF patients initially managed and up‐titrated to optimal treatment at a specialized HF clinic. Methods and results We conducted a multicentre, randomized, controlled study in 189 HF patients (62% male, age 72 ± 11 years), who were assigned to follow‐up either in primary care (n = 97) or in a HF clinic (n = 92). After 12 months, no differences between guideline adherence, as estimated by the Guideline Adherence Indicator (GAI‐3), and patient adherence, in terms of the medication possession ratio (MPR), were found between treatment groups. There was no difference in the number of deaths (n = 12 in primary care and n = 8 in the HF clinic; P = 0.48), and hospital readmissions for cardiovascular (CV) reasons were also similar. The total number of unplanned non‐CV hospital readmissions, however, tended to be higher in the primary care group (n = 22) than in the HF clinic group (n = 10; P = 0.05). Conclusions Patients discharged after initial management in a specialized HF clinic can be discharged to primary care for long‐term follow‐up with regard to maintaining guideline adherence and patient adherence. However, the complexity of the HF syndrome and its associated co‐morbidities requires continuous monitoring. Close collaboration between healthcare providers will be crucial in order to provide HF patients with optimal, integrated care.