Swipe om te navigeren naar een ander artikel
Since the number of heart failure (HF) patients is still growing and long-term treatment of HF patients is necessary, it is important to initiate effective ways for structural involvement of primary care services in HF management programs. However, evidence on whether and when patients can be referred back to be managed in primary care is lacking.
To determine whether long-term patient management in primary care, after initial optimisation of pharmacological and non-pharmacological treatment in a specialised HF clinic, is equally effective as long-term management in a specialised HF clinic in terms of guideline adherence and patient compliance.
The study is designed as a randomised, controlled, non-inferiority trial. Two-hundred patients will be randomly assigned to be managed and followed in primary care or in a HFclinic. Patients are eligible to participate if they are (1) clinically stable, (2) optimally up-titrated on medication (according to ESC guidelines) and, (3) have received optimal education and counselling on pre-specified issues regarding HF and its treatment. Furthermore, close cooperation between secondary and primary care in terms of back referral to or consultation of the HF clinic will be provided.The primary outcome will be prescriber adherence and patient compliance with medication after 12 months. Secondary outcomes measures will be readmission rate, mortality, quality of life and patient compliance with other lifestyle changes.
The results of the study will add to the understanding of the role of primary care and HF clinics in the long-term follow-up of HF patients.
Log in om toegang te krijgen
Met onderstaand(e) abonnement(en) heeft u direct toegang:
Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail. 2008;10:933–89. PubMedCrossRef
McAlister FA, Stewart S, Ferrua S, et al. Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol. 2004;44:810–9. PubMed
McDonagh TA, Blue L, Clark AL, et al. ESC Heart Failure Association Standards for Delivering Heart Failure Care. Eur J Heart Fail 2010;Dec 15. [Epub ahead of print]
NHG standaard Hartfalen; eerste herziening. Huisarts en Wetenschap 2009;48:64–76.
Bosch M, Wensing M, Bakx JC, et al. Current treatment of chronic heart failure in primary care; still room for improvement. J Eval Clin Pract. 2010;16:644–50. PubMed
Fuat A, Hungin AP, Murhpy JJ. Barriers to accurate diagnosis and effective management of heart failure in primary care: qualitative study. BMJ 2003;326.
Peters-Klimm F, Muller-Tasch, Remppis A, et al. Improved guideline adherence to pharmacotherapy of chronic systolic heart failure in general practice; results from a cluster randomized controlled trial of implementation of a clinical practice guideline. J Eval ClinPract. 2008;14:823–9. CrossRef
Schuchtert A, BISEX Investigators. Effect of bisoprolol treatment for chronic heart failure initiated and followed up by primary care physicians. Eur J Heart Fail. 2005;7:604–11. CrossRef
Guadagnoli E, Normand SL, DiSalvo TG, et al. Effects of treatment recommendations andspecialist intervention on care provided by primary care physicians to patients with myocardial infarction or heart failure. Am J Med. 2004;117:433–5. CrossRef
Hoes AW, Voors AA, Rutten FH, et al. NHG standaard Hartfalen. Huisarts & Wetenschap. 2010;7:368–89.
van der Wal MH, Jaarsma T, Moser DK, et al. Unraveling the mechanisms for heart failure patients’ beliefs about compliance. Eur Heart J. 2007;36:253–61.
Ware JE, Kosinski M, Keller SD. SF-36 physical and mental health. Health Survey, Manual and Interpretation Guide. Boston, MA: The Health Institute, New England Medical Centre; 1994.
EuroQol--a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 1990;16:199–208.
Radloff L. A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401. CrossRef
Moser DK, Dracup K. Psychosocial recovery from a cardiac event: The influence of perceived control. Heart & Lung. 1995;4:273–80.
- Design and methodology of the COACH-2 (Comparative study on guideline adherence and patient compliance in heart failure patients) study: HF clinics versus primary care in stable patients on optimal therapy
M. L. A. Luttik
H. L. Hillege
R. de Jong
D. J. Lok
D. J. van Veldhuisen
- Bohn Stafleu van Loghum