The Canadian CHF Clinics Network: Referral practices and treatment

Abstract:

Introduction: The Canadian CHF Clinics Network has been
established in 11 initial centers across Canada to document the
presentation of chronic heart failure (CHF), to improve current
management, and to collaborate in innovative research approaches
to optimize patient outcomes. A national computerized database
has been operational since January 1999. The present study, which
to establish the referral patterns of CHF patients to specialize
CHF clinics in Canada.
Results: Of 884 patients entered into the database in the first
year, majority were male (72%), majority were young (average age
63 years), 20% (over the age of 75) had systolic heart failure
(average LVEF 27%, only 8% with LVEF of over 45%), majority were
in NYHA Classes II and III (33% and 44% respectively), majority
had ischemic cardiomyopathy (48%).
History of hypertension was present in 34% and dyslipidemia, 23%
diabetes and 22% valvular disease and 13%, 7% current smokers and
morbid obesity and 6%. Depression was prevalent at 12% and
alcohol abuse at 2%. 76% of patients were on ACE Inhibitors and
52% were on beta blockers.
Conclusion: The role of specialized heart failure clinic
incorporate both physicians an nurses has been shown to have an
impact on recurrent hospitalization, the population of patients
referred to such clinics in Canada appears under representative
of some patient groups.
In particular, elderly (women), patients with diastolic heart
failure, diabetic idiopathic cardiomyopathy, NYHA Class IV appear
to be under represented in the referral sample. Whether or not
this represents "referral bias" related to the present patterns
of practice or whether these groups are systematically under
referred remains to be seen in the second year referral data.
These data support need for more research in these areas of
treatment choices and also educational outreach programs to
enhance appropriate referral of these patients in the
community.