Benefit of specialized clinics for the treatment of patients with heart failure

Abstract

Background Current guidelines recommend special attention for heart failure (HF) patients in dedicated outpatient units. Aims and methods In this observational cohort study we sought to determine whether an equivalent benefit is achieved in all HF patients treated in specialized heart failure clinics. Patients were stratified to patients recently referred and those who already receiving long-term care (> 1 year). Data were collected at baseline and after 12 months. Results 474 patients were prospectively observed. 130 subjects were recently referred and 344 subjects had received long-term care. During follow-up of recently referred patients, enhancement of neurohumoral pharmacotherapy was achieved in 67% (p < 0.001), which was paralleled by a reduction in NT-proBNP (baseline 1779 pg/ml [range 458;4685]; after 12 months 668 pg/ml [range 167;1690]; p < 0.001) and improvement in quality of life score, measured by the Minnesota Living with Heart Failure Questionnaire by 8 points [range 0;23]; (at baseline 34 points [range 16;59], and after 12 months 15 points [range 5;42]; p = 0.04). In contrast, these parameters were unchanged in long-term care patients. Hospitalization for HF and other cardiovascular causes was higher in patients recently referred, and all-cause mortality was comparable in both groups. Conclusions This comprehensive analysis of chronic HF patients treated in a specialized HF outpatient clinic confirmed the potential to optimize pharmacotherapy paralleled by improvements in quality of life and NT-proBNP levels in patients referred within the first 12 months. Prolonged management of HF patients after this optimization of maintenance therapy yields little additional benefit.