Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study

Marie Louise A Luttik, Tiny Jaarsma, Peter Paul van Geel, Maaike Brons, Hans L Hillege, Arno W Hoes, Richard de Jong, Gerard Linssen, Dirk J A Lok, Marjolein Berge, Dirk J van Veldhuisen

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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.

Original languageEnglish
Pages (from-to)1241-1248
JournalEuropean journal of heart failure
Volume16
Issue number11
DOIs
Publication statusPublished - Nov 2014
Externally publishedYes

Keywords

  • disease management
  • guideline adherence
  • heart failures
  • medication adherence
  • primary health care

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    Luttik, M. L. A., Jaarsma, T., van Geel, P. P., Brons, M., Hillege, H. L., Hoes, A. W., de Jong, R., Linssen, G., Lok, D. J. A., Berge, M., & van Veldhuisen, D. J. (2014). Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study. European journal of heart failure, 16(11), 1241-1248. https://doi.org/10.1002/ejhf.173