TY - JOUR
T1 - Extended heart failure clinic follow-up in low-risk patients
T2 - A randomized clinical trial (NorthStar)
AU - Schou, Morten
AU - Gustafsson, Finn
AU - Videbaek, Lars
AU - Tuxen, Chr
AU - Keller, Niels
AU - Handberg, Jens
AU - Sejr Knudsen, Anne
AU - Espersen, Geert Tschentscher
AU - Markenvard, John
AU - Egstrup, Kenneth
AU - Ulriksen, Hans
AU - Hildebrandt, Per R.
AU - NorthStar Investigators
AU - Korup, Eva
AU - Broberg, Helle
AU - Nielsen, Vivi Lindeborg
AU - Pedersen, Mette Storgaard
AU - Pedersen, Henriette P.
AU - Dam, Anette
AU - Christensen, Tove
AU - Thude, Lilli
AU - Gohr, Thomas
AU - Madsen, Bodil S.
AU - Nielsen, Hanne-Lis
AU - Rosenberg, Jens
AU - Egstrup, Michael
AU - Jensen, Anna-Marie
AU - Hemmingshøj, Jeanett
AU - Bartholdy, Hanne
AU - Groth, Susanne
AU - Leth, Gitte
AU - Jensen, Marianne
AU - Sejrsen, Holger
AU - Skaarstad, Ellen
AU - Larsen, Ingelise
AU - Jensen, Jannie
AU - Borrild, Anne-Mette
AU - Mogelhoj, Birthe
AU - Claussen, Jimi
AU - Jacobsen, Vibeke
AU - Kaiser-Nielsen, Peter
AU - Woelders, Lone
AU - Viem, Nina
AU - Oechsler, Louise
AU - Knoefler, Inge-Lise
AU - Karlsson, Kristina
AU - Egeberg, Helle
AU - Pedersen, Mette R.
AU - Milton, Janne
AU - Anker, Charlotte
AU - Thomassen, Camilla
PY - 2013/2/18
Y1 - 2013/2/18
N2 - BackgroundOutpatient follow-up in specialized heart failure clinics (HFCs) is recommended by current guidelines and implemented in most European countries, but the optimal duration of HFC programmes has not been established. Nor is it known whether all or only high-risk patients, e.g. identified by NT-proBNP, might benefit from an extended HFC follow-up.Methods and resultsIn a multi-centre setting, we randomly assigned 921 clinically stable systolic heart failure (HF) outpatients on optimal medical therapy to undergo either an extended follow-up in the HFC (n = 461) or referral back to their general practitioner (GP) (n = 460). The primary composite endpoint was death or a cardiovascular admission. Secondary endpoints included mortality, an HF admission, quality of life, number of days admitted, and number of admissions. The median age of the patients was 69 years; 23% were females; the median left ventricular ejection fraction was 0.30; and the median NT-proBNP was 801 pg/mL; 89% were in NYHA class I-II. The median follow-up was 2.5 years. Time-to-event did not differ between groups (HFC vs. GP) (HR: 1.17, 95% CI: 0.95-1.45, P = 0.149). The two groups did not differ with respect to any of the secondary endpoints at the follow-up (P> 0.05 for all). In high-risk patients identified by NT-proBNP ≥1000 pg/mL, no benefit from HFC follow-up was found (P = 0.721).ConclusionIrrespective of the level of NT-proBNP stable HF patients on optimal medical therapy do not benefit from long-term follow-up in a specialized HFC in a publicly funded universal access healthcare system. Heart failure patients on optimal medical therapy with mild or moderate symptoms are safely managed by their personal GP.Trial Registration: www.Centerwatch.com: 173491 (NorthStar).
AB - BackgroundOutpatient follow-up in specialized heart failure clinics (HFCs) is recommended by current guidelines and implemented in most European countries, but the optimal duration of HFC programmes has not been established. Nor is it known whether all or only high-risk patients, e.g. identified by NT-proBNP, might benefit from an extended HFC follow-up.Methods and resultsIn a multi-centre setting, we randomly assigned 921 clinically stable systolic heart failure (HF) outpatients on optimal medical therapy to undergo either an extended follow-up in the HFC (n = 461) or referral back to their general practitioner (GP) (n = 460). The primary composite endpoint was death or a cardiovascular admission. Secondary endpoints included mortality, an HF admission, quality of life, number of days admitted, and number of admissions. The median age of the patients was 69 years; 23% were females; the median left ventricular ejection fraction was 0.30; and the median NT-proBNP was 801 pg/mL; 89% were in NYHA class I-II. The median follow-up was 2.5 years. Time-to-event did not differ between groups (HFC vs. GP) (HR: 1.17, 95% CI: 0.95-1.45, P = 0.149). The two groups did not differ with respect to any of the secondary endpoints at the follow-up (P> 0.05 for all). In high-risk patients identified by NT-proBNP ≥1000 pg/mL, no benefit from HFC follow-up was found (P = 0.721).ConclusionIrrespective of the level of NT-proBNP stable HF patients on optimal medical therapy do not benefit from long-term follow-up in a specialized HFC in a publicly funded universal access healthcare system. Heart failure patients on optimal medical therapy with mild or moderate symptoms are safely managed by their personal GP.Trial Registration: www.Centerwatch.com: 173491 (NorthStar).
KW - Heart failure clinic
KW - NT-ProBNP
KW - Randomized clinical trial
KW - Systolic heart failure
U2 - 10.1093/eurheartj/ehs235
DO - 10.1093/eurheartj/ehs235
M3 - Journal article
C2 - 22875412
AN - SCOPUS:84873654604
SN - 0195-668X
VL - 34
SP - 432
EP - 442
JO - European Heart Journal (Online)
JF - European Heart Journal (Online)
IS - 6
ER -