Specialized heart failure clinics versus primary care: Extended registry-based follow-up of the NorthStar trial

• Published in: PloS one Vol. 18; no. 6; p. e0286307
• Main Authors: Malmborg, Morten, Assad Turky Al-Kahwa, Ali, Kober, Lars, Torp-Pedersen, Christian, Butt, Jawad H, Zahir, Deewa, Tuxen, Christian D, Poulsen, Mikael K, Madelaire, Christian, Fosbol, Emil, Gislason, Gunnar, Hildebrandt, Per, Andersson, Charlotte, Gustafsson, Finn, Schou, Morten
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 08.06.2023; Public Library of Science (PLoS)
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Angiotensin; Angiotensin Receptor Antagonists; Angiotensin-converting enzyme inhibitors; Care and treatment; Case reports; Clinics; Confidence intervals; Congestive heart failure; Death; Diagnosis; Drug dosages; Ejection fraction; Emigration; Enzyme inhibitors; Female; Follow-Up Studies; Health aspects; Health care; Health risks; Heart failure; Heart Failure - drug therapy; Hospitalization; Humans; Immigration; Male; Medical research; Medicine and Health Sciences; Medicine, Experimental; Mortality; Optimization; Patients; People and Places; Peptidyl-dipeptidase A; Pharmaceutical industry; Primary care; Primary Health Care; Registries; Stroke Volume; Denmark
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0286307

Whether continued follow-up in specialized heart failure (HF) clinics after optimization of guideline-directed therapy improves long-term outcomes in patients with HF with reduced ejection fraction (HFrEF) is unknown. 921 medically optimized HFrEF patients enrolled in the NorthStar study were randomly assigned to follow up in a specialized HF clinic or primary care and followed for 10 years using Danish nationwide registries. The primary outcome was a composite of HF hospitalization or cardiovascular death. We further assessed the 5-year adherence to prescribed neurohormonal blockade in 5-year survivors. At enrollment, the median age was 69 years, 24,7% were females, and the median NT-proBNP was 1139 pg/ml. During a median follow-up time of 4.1 (Q1-Q3 1.5-10.0) years, the primary outcome occurred in 321 patients (69.8%) randomized to follow-up in specialized HF clinics and 325 patients (70.5%) randomized to follow-up in primary care. The rate of the primary outcome, its individual components, and all-cause death did not differ between groups (primary outcome, hazard ratio 0.96 [95% CI, 0.82-1.12]; cardiovascular death, 1.00 [0.81-1.24]; HF hospitalization, 0.97 [0.82-1.14]; all-cause death, 1.00 [0.83-1.20]). In 5-year survivors (N = 660), the 5-year adherence did not differ between groups for angiotensin-converting enzyme inhibitors (p = 0.78), beta-blockers (p = 0.74), or mineralocorticoid receptor antagonists (p = 0.47). HFrEF patients on optimal medical therapy did not benefit from continued follow-up in a specialized HF clinic after initial optimization. Development and implementation of new monitoring strategies are needed.