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Published on: December 11, 2017

Are there long-term benefits in following stable heart failure patients in a heart failure clinic?

Tina H Leetmaa1, Henrik Villadsen, Kirsten V Mikkelsen

  • 1Department of Cardiology, Odense University Hospital, Denmark. tina.leetmaa.@gmail.com

Scandinavian Cardiovascular Journal : SCJ
|December 10, 2008
PubMed

Insights

Heart failure clinics improve medication and function for patients with mild to moderate heart failure (HF), but do not significantly reduce hospitalizations or death compared to usual care.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Public Health

Background:

  • Stable mild to moderate heart failure (NYHA II-III) requires effective long-term management strategies.
  • Heart failure (HF) clinics offer specialized care, but their impact on long-term outcomes versus usual care (UC) needs further evaluation.
  • Understanding the benefits of HF clinic follow-up is crucial for optimizing patient care pathways.

Purpose of the Study:

  • To compare the long-term outcomes of patients with mild to moderate heart failure randomized to either continued HF clinic follow-up or usual care.
  • To assess the impact of HF clinic care on unplanned hospitalizations, mortality, pharmacological therapy, functional status, and biomarker levels.
  • To determine if specialized HF clinic management offers advantages over standard care for stable patients.

Main Methods:

  • A randomized controlled trial involving 163 patients with stable mild to moderate heart failure (NYHA II-III).
  • Patients were allocated to either continued follow-up in a dedicated HF clinic or to usual care.
  • Primary outcome: unplanned hospitalizations and death. Secondary outcomes: pharmacological therapy, NYHA class, 6-minute walking distance, and NT-pro BNP levels.

Main Results:

  • No significant differences were observed in the total number of hospitalizations (p = 0.2) or mortality rates (16% vs. 16%) between the HF clinic and usual care groups.
  • Patients managed in the HF clinic demonstrated significantly improved NYHA class (p < 0.01) and longer 6-minute walking distances (p = 0.04).
  • HF clinic patients received significantly higher doses of ACE inhibitors (p < 0.001) and beta-blockers (p < 0.001), with no significant difference in NT-pro BNP levels (p = 0.4).

Conclusions:

  • Long-term follow-up in a heart failure clinic can enhance pharmacological therapy and improve functional status in patients with mild to moderate HF.
  • Specialized HF clinic care did not lead to a significant reduction in unplanned hospitalizations or mortality compared to usual care.
  • These findings suggest that while HF clinics improve specific patient metrics, their impact on major adverse cardiovascular events requires further investigation.
Abstract

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