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

Research output: Contribution to journalArticleAcademicpeer-review

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

Cite this

Luttik, Marie Louise A ; Jaarsma, Tiny ; van Geel, Peter Paul ; Brons, Maaike ; Hillege, Hans L ; Hoes, Arno W ; de Jong, Richard ; Linssen, Gerard ; Lok, Dirk J A ; Berge, Marjolein ; van Veldhuisen, Dirk J. / Long-term follow-up in optimally treated and stable heart failure patients : primary care vs. heart failure clinic. Results of the COACH-2 study. In: European journal of heart failure. 2014 ; Vol. 16, No. 11. pp. 1241-1248.
@article{adda57b1fe4942db8fe514c081b5ff89,
title = "Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study",
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.",
keywords = "disease management, guideline adherence, heart failures, medication adherence, primary health care, hartfalen, medicatie , gezondheidszorg",
author = "Luttik, {Marie Louise A} and Tiny Jaarsma and {van Geel}, {Peter Paul} and Maaike Brons and Hillege, {Hans L} and Hoes, {Arno W} and {de Jong}, Richard and Gerard Linssen and Lok, {Dirk J A} and Marjolein Berge and {van Veldhuisen}, {Dirk J}",
note = "{\circledC} 2014 The Authors. European Journal of Heart Failure {\circledC} 2014 European Society of Cardiology.",
year = "2014",
month = "11",
doi = "10.1002/ejhf.173",
language = "English",
volume = "16",
pages = "1241--1248",
journal = "European journal of heart failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "11",

}

Luttik, MLA, Jaarsma, T, van Geel, PP, Brons, M, Hillege, HL, Hoes, AW, de Jong, R, Linssen, G, Lok, DJA, Berge, M & van Veldhuisen, DJ 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, vol. 16, no. 11, pp. 1241-1248. https://doi.org/10.1002/ejhf.173

Long-term follow-up in optimally treated and stable heart failure patients : primary care vs. heart failure clinic. Results of the COACH-2 study. / Luttik, Marie Louise A; Jaarsma, Tiny; van Geel, Peter Paul; Brons, Maaike; Hillege, Hans L; Hoes, Arno W; de Jong, Richard; Linssen, Gerard; Lok, Dirk J A; Berge, Marjolein; van Veldhuisen, Dirk J.

In: European journal of heart failure, Vol. 16, No. 11, 11.2014, p. 1241-1248.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Long-term follow-up in optimally treated and stable heart failure patients

T2 - primary care vs. heart failure clinic. Results of the COACH-2 study

AU - Luttik, Marie Louise A

AU - Jaarsma, Tiny

AU - van Geel, Peter Paul

AU - Brons, Maaike

AU - Hillege, Hans L

AU - Hoes, Arno W

AU - de Jong, Richard

AU - Linssen, Gerard

AU - Lok, Dirk J A

AU - Berge, Marjolein

AU - van Veldhuisen, Dirk J

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

PY - 2014/11

Y1 - 2014/11

N2 - 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.

AB - 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.

KW - disease management

KW - guideline adherence

KW - heart failures

KW - medication adherence

KW - primary health care

KW - hartfalen

KW - medicatie

KW - gezondheidszorg

U2 - 10.1002/ejhf.173

DO - 10.1002/ejhf.173

M3 - Article

VL - 16

SP - 1241

EP - 1248

JO - European journal of heart failure

JF - European journal of heart failure

SN - 1388-9842

IS - 11

ER -