Extended heart failure clinic follow-up in low-risk patients: a randomized clinical trial (NorthStar)

Area of Science:

• Cardiology
• Heart Failure Management

Background:

• Current guidelines recommend specialized heart failure clinics (HFCs) for outpatient follow-up.
• The optimal duration and patient selection for extended HFC programs remain unclear.
• It is unknown if high-risk patients, identified by NT-proBNP, benefit from prolonged HFC care.

Purpose of the Study:

• To determine if extended follow-up in a specialized heart failure clinic (HFC) improves outcomes for stable systolic heart failure patients on optimal medical therapy compared to general practitioner (GP) care.
• To assess if high-risk patients, defined by NT-proBNP levels, benefit from extended HFC follow-up.

Main Methods:

• A multi-center randomized trial assigned 921 stable systolic heart failure outpatients to either extended HFC follow-up or usual care by their GP.
• The primary endpoint was a composite of death or cardiovascular admission.
• Secondary endpoints included mortality, heart failure admissions, quality of life, and healthcare utilization.

Main Results:

• No significant difference was observed in the primary composite endpoint between the HFC and GP groups (HR: 1.17, P=0.149).
• Secondary endpoints, including mortality and HF admissions, also showed no significant differences between the groups.
• Extended HFC follow-up did not benefit high-risk patients identified by NT-proBNP ≥1000 pg/mL (P=0.721).

Conclusions:

• Stable heart failure patients on optimal medical therapy do not benefit from long-term specialized HFC follow-up, regardless of NT-proBNP levels.
• General practitioners are capable of safely managing heart failure patients with mild to moderate symptoms in a universal healthcare system.
• Current practice of extended HFC follow-up for all stable heart failure patients may not be necessary.