Changes in Heart Failure Drug Utilization During 1999: The Canadian CHF Clinics Network Experience

Abstract:

Background: The Canadian CHF Clinics Network was established to improve the current management of CHF, to implement new proven strategies in a timely manner, and to monitor treatment trends in 11 initial centres across Canada. The first formal meeting of the Network members was in July 1998 when, through consensus, a manual of CHF management for physicians, nurses, and patients was developed.
Methods: A computerized database was designed and implemented in Jan 1999 and 883 patients were seen and had their data entered in the first 12 months. These patients represent both new patients to the clinic and some previously seen in the clinic but who were being entered into the longitudinal database for the first time.
Results: Selected mean baseline characteristics of these patients were: age 64 years; male 72%; ischemic aetiology 62%; NYHA Class I 13.0%, II 34.8%, III 40.8%, IV 11.4%; LVEF 24%. Drug utilization changed from the first to the last quarter of 1999 with an increase in ramipril (27.1 vs 10.3%, p<0.0001) while all ACE-I use remained constant (70.3%), and spironolactone (31.8 vs 5.0%, p<0.0001). Beta blocker use was 39.9% but showed a nonsignificant increase to 44.7% (carvedilol 22.4%, metoprolol 20.6%). Furosemide and digoxin use remained unchanged at 69.4 vs 73.4% and 50.0 vs 50.5% respectively. The physician-patient interaction resulted in a change of drug treatment in 46% of encounters and education regarding medication in 46%, CHF 42%, fluid/salt 42%, home weight monitoring 42%, and exercise 27% respectively.
Conclusion: Several important major clinical trials were presented or published in 1998/99 including HOPE, RALES, CIBIS-2, MERIT-HF, and BEST. The impact of these trials was rapidly assimilated into clinical practice. The clinics emphasized the importance of patient education of their disease, their medications and early warning signs of worsening heart failure. Assessment of clinical outcomes is being prospectively captured within the Network database. While national utilization of the same medications in general medical practice over the same time period is not available at this time, the data support the role of such clinics in translating clinical trials into clinical practice.