Community Versus Congestive Heart Failure (CHF) Clinic Drug Utilization: The Canadian CHF Clinics Network 1999-2000

Abstract:

The Canadian CHF Clinics Network was established to link an
initial 11 centres across Canada into a national computerized
longitudinal database. Patients are referred to the clinics which
are run by physicians and nurses with specialized expertise in
CHF management. National guidelines exist for the management of
CHF and the Network does not specifically mandate treatment
algorithms outside these guidelines. In some centres, CHF Clinics
pre existed the network formation and thus, at the time of first
data entry into the database, each patient was classified as new
(first time seen by the clinic staff) or previously seen (follow
up Visit).
There was no difference between new (n=1155) or previously seen
(n=778) patients in age (62.4±15.5 sd vs 62.8±14.2
yrs), LVEF (29.8±14.4 vs 31.2±13.9%), etiology
(ischemic: 57.5 vs 58.9%) or NYHA (I, 11 vs 13%; II, 35 vs 40%;
III, 42 vs 39%; IV, 12 vs 7%). Drug utilization patterns
different between new (community use) and previously seen (clinic
use) patients: digoxin (49 vs 66%, p 0.01) furosemide (76 vs 82%
p 0.01), ACE-I (79 vs 81% p=ns), beta blockers (49 vs 58% p
0.01), lipid lowering therapy (13 vs 15% p 0.01). These 1933
patients enrolled in 1999-2000, were referred for CHF management
but are otherwise an unselected population. The use of ACE-I by
community physicians was not increased by CHF specialists but the
use of beta blockers, diuretics, digoxin and lipid treatments
were increased. CHF clinics may improve and optimize drug
utilization in CHF but clinical outcomes need to be evaluated in
this broad range of patients.