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The Canadian Heart Failure (CAN-HF) Registry: A Canadian Multicentre, Retrospective Study of Outpatients with Heart
Dimitar Saveski1, Melanie Kok2, Stephanie Poon3
1St Joseph's Health Care, Western University, London, Ontario, Canada.
Insights
Guideline-directed medical therapy (GDMT) improves outcomes for heart failure with reduced ejection fraction (HFrEF). Specialized heart failure clinics (HFCs) in Canada showed improved GDMT prescription rates over time, especially with longer patient follow-up.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Guideline-directed medical therapy (GDMT) is crucial for managing heart failure (HF) with reduced ejection fraction (HFrEF).
- Underutilization of GDMT remains a challenge despite its proven benefits.
- This study examines HF management in Canadian outpatient specialized heart failure clinics (HFCs).
Purpose of the Study:
- To describe the utilization of GDMT in Canadian outpatient HFCs.
- To identify trends in GDMT prescription rates over time.
- To compare GDMT use based on patient follow-up duration at HFCs.
Main Methods:
- Retrospective, observational study (Canadian Heart Failure [CAN-HF] study).
- Included 1775 patients from 6 Canadian outpatient HFCs (January 2017–April 2020).
- Analyzed GDMT prescription rates at first visit versus most recent clinic visit.
Main Results:
- Improved GDMT prescription rates observed across all classes for patients followed ≥ 6 months.
- Angiotensin receptor-neprilysin inhibitors and mineralocorticoid-receptor antagonists showed the largest increases.
- Over half of symptomatic HFrEF patients remained on older therapies; 50% were on triple therapy at the most recent visit.
- Patients managed > 6 months had higher GDMT prescription rates and doses.
- Limited use of candesartan and mineralocorticoid-receptor antagonists in HF with preserved ejection fraction.
Conclusions:
- Canadian HFCs demonstrate favorable GDMT utilization compared to other analyses.
- Specialized HF patient-care models appear effective in improving GDMT adherence.
- Further optimization of GDMT, particularly for symptomatic patients, is warranted.
Background:
Guideline-directed medical therapy (GDMT) reduces events in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Despite this impact, underutilization of GDMT persists. This report sought to describe HF management in Canadian outpatients treated at specialized HF clinics (HFCs).
Methods:
The Canadian Heart Failure (CAN-HF) study was retrospective and observational, and it included 1775 patients from 6 Canadian outpatient HFCs, from the period January 2017-April 2020.
Results:
We observed improvement in prescription rates in patients with HFrEF, between their first visit and their most-recent clinic visit, across all GDMT classes, in those who were followed at the HFC for ≥ 6 months. The largest prescription rate increases were observed for angiotensin receptor-neprilysin inhibitors and mineralocorticoid-receptor antagonists. However, more than half of the patients remained on angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers, despite being symptomatic, according to their New York Heart Association class. Most patients (50%) were on triple therapy, as of their most-recent visit, with fewer (36%) on dual therapy, monotherapy (13%), or no GDMT (2%). Our data also suggest that patients who had been managed at the HFC for > 6 months had higher prescription rates of GDMT and were on higher doses of GDMT, compared to those who were new to the clinic. For patients with HF with preserved ejection fraction, few patients were on candesartan and less than half were on a mineralocorticoid-receptor antagonist.
Conclusions:
Our data from HFCs that in most cases were affiliated with academic centres compare favourably with data from other analyses of ambulatory patients with HFrEF, evidence that supports the use of a specialized patient-care model.
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