Abstract
BackgroundHeart failure (HF) is mainly detected and managed in primary care, but the care is considered suboptimal. We present the rationale, design and baseline results of the Treatment Optimisation in Primary care of Heart failure in the Utrecht region (TOPHU) study. In this study we assess the effect of a single training of GPs in the pharmacological management of patients with HF.Methods/designA cluster randomised controlled trial. Thirty primary care practices are randomly assigned to care as usual or intervention defined as a single training in the up-titration and management of HF drug therapy according to the heart failure guidelines of the European Society of Cardiology (ESC). Patients with a GP’s diagnosis of HF will be re-evaluated by an expert panel of two cardiologists and a GP with expertise in HF to come to a definite diagnosis of HF according to the ESC heart failure guidelines. Those with definite HF will be analysed in this study. Drug use will be measured after six months, health status after twelve months, and heart-related hospital admissions and all-cause mortality after two years.DiscussionOur cluster randomised trial will show whether a single training of GPs improves the pharmacological management of patients with HF and confers beneficial effects on health status after one year, and cardiac hospital admissions and all-cause mortality after two years of follow-up.Trial registrationClinicalTrials.gov Identifier NCT01662323
Highlights
Heart failure (HF) is mainly detected and managed in primary care, but the care is considered suboptimal
Our cluster randomised trial will show whether a single training of General practitioner (GP) improves the pharmacological management of patients with HF and confers beneficial effects on health status after one year, and cardiac hospital admissions and all-cause mortality after two years of follow-up
In a randomised trial we will quantify the effect on drug use, health status and prognosis with hospital admissions, and all-cause mortality of a single training of GP’s that is focused on the drug management of patients with definite HF, and for HF with a preserved reduced ejection fraction (HFrEF) and HFpEF seperately
Summary
Heart failure (HF) is mainly detected and managed in primary care, but the care is considered suboptimal. The initial diagnosis of HF is mainly made in primary care, and is still often based on the clinical assessment only, irrespective of the general knowledge that such a diagnosis solely based on clinical grounds, without echocardiography bares the risk of both overdiagnosis and underdiagnosis, certainly in the. Previous studies showed that general practitioners (GPs) are less successful than cardiologists in uptitrating HF drugs according to guidelines [2, 3, 6,7,8,9]. They adequately maintain the drug management initiated in secondary care, as good as done in heart failure clinics [10, 11]
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