[Establishment of a nurse-led heart failure clinic. Design and baseline data from the first two years].
BACKGROUND
Previous studies on the effect of heart failure clinics have shown a reduction in hospitalizations, reduced cost and improved quality of life.


METHODS
We report on the establishment of a heart failure clinic and its impact on heart failure hospitalizations. Since September 1, 1999, a heart failure clinic has been operated at the Frederiksberg University Hospital. The clinic was designed with both a diagnostic and a therapeutic unit. The diagnostic unit offers open access to all patients with suspected heart failure, either through referral from general practitioners or from the medical departments of the hospital. In case of confirmed systolic heart failure, the patient is referred to the therapeutic unit.


RESULTS
During the two years of operation, a total of 510 patients were registered in a newly established database (HJERTER+). Of these, 352 (69%) were found to have clinical evidence of heart failure, and 304 (86% of the heart failure patients) had left ventricular (LV) systolic dysfunction (ejection fraction < or = 0.45). Before referral, most patients with LV dysfunction had been treated with no or insufficient dose of ACE inhibitor (55%), and one third received beta-blockers (32%). During the two years of operation of the clinic, there was a 23% decline in heart failure related hospital admissions to the department of cardiology.


CONCLUSIONS
Patients with systolic heart failure are not always optimally treated. The establishment of a heart failure clinic offering the combination of diagnosing and managing congestive heart failure appears to be effective both in terms of therapy optimization and with respect to a concomitant decline in hospitalization for heart failure.
Galatius
Søren
S
H:S Frederiksberg Hospital, kardiologisk-endokrinologisk klinik E. galatius@dadlnet.dk
Gustafsson
Finn
F
Kistorp
Caroline M N
CM
Nielsen
Per H
PH
Atar
Dan
D
Hildebrandt
Per Rossen
PR
D000368:Aged; D003718:Denmark; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics / Q000451:nursing; D017721:Hospital Costs; D006757:Hospital Units / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009745:Nursing, Supervisory; D010343:Patient Admission / Q000706:statistics & numerical data; D012017:Referral and Consultation; D012042:Registries; D000078329:Workforce