Characteristics, implementation of evidence-based management and outcome in patients with chronic heart failure: results from the Norwegian heart failure registry.
BACKGROUND
Hospitalization rates, morbidity and mortality are undesirably high in heart failure (HF) patients. An organized system of HF specialist outpatient care has been recommended, but the best way to implement such programmes is not clearly established.


OBJECTIVE
To evaluate HF patient characteristics, management and outcome in outpatient HF clinics.


METHODS
Data from HF patients at 24 hospital outpatient clinics were entered in a common database allowing each centre to monitor its own practice against the rest.


RESULTS
A total of 3632 patients were included. At the last registered visit, ACE inhibitors or angiotensin receptor blockers were prescribed for 87%; beta blockers, 83%; spironolactone, 33% and loop diuretics 87% of the patients. The number of hospital admissions and days stayed in hospital for cardiovascular reasons were significantly reduced (p<0.001). Mortality was high, 11.5 and 22% after one and two years, respectively.


CONCLUSIONS
The use of evidence-based medication increased over time in HF clinics with the ability of the individual clinics to compare their treatment to other sites. Thus, establishment of specialized HF clinics managed in a registry network might improve the quality of care.
Grundtvig
Morten
M
Innlandet Hospital Trust, Division Lillehammer, Department of Medicine, Lillehammer, Norway. mgrundtv@online.no
Gullestad
Lars
L
Hole
Torstein
T
Flønæs
Berit
B
Westheim
Arne
A
D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002908:Chronic Disease; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D016896:Treatment Outcome