title: Extended heart failure clinic follow-up in low-risk patients: a randomized clinical trial (NorthStar).
abstract: BACKGROUND
  Outpatient follow-up in specialized heart failure clinics (HFCs) is recommended by current guidelines and implemented in most European countries, but the optimal duration of HFC programmes has not been established. Nor is it known whether all or only high-risk patients, e.g. identified by NT-proBNP, might benefit from an extended HFC follow-up.
  
  
  RESULTS
  In a multi-centre setting, we randomly assigned 921 clinically stable systolic heart failure (HF) outpatients on optimal medical therapy to undergo either an extended follow-up in the HFC (n = 461) or referral back to their general practitioner (GP) (n = 460). The primary composite endpoint was death or a cardiovascular admission. Secondary endpoints included mortality, an HF admission, quality of life, number of days admitted, and number of admissions. The median age of the patients was 69 years; 23% were females; the median left ventricular ejection fraction was 0.30; and the median NT-proBNP was 801 pg/mL; 89% were in NYHA class I-II. The median follow-up was 2.5 years. Time-to-event did not differ between groups (HFC vs. GP) (HR: 1.17, 95% CI: 0.95-1.45, P = 0.149). The two groups did not differ with respect to any of the secondary endpoints at the follow-up (P> 0.05 for all). In high-risk patients identified by NT-proBNP ≥1000 pg/mL, no benefit from HFC follow-up was found (P = 0.721).
  
  
  CONCLUSIONS
  Irrespective of the level of NT-proBNP stable HF patients on optimal medical therapy do not benefit from long-term follow-up in a specialized HFC in a publicly funded universal access healthcare system. Heart failure patients on optimal medical therapy with mild or moderate symptoms are safely managed by their personal GP.
  
  
  BACKGROUND
  www.Centerwatch.com: 173491 (NorthStar).
authors.affiliation: Department of Cardiology and Endocrinology, Frederiksberg University Hospital, DK-2000 Frderiksberg, Denmark. m.schou@dadlnet.dk
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.forename: Lars
authors.initials: L
authors.lastname: Videbaek
authors.forename: Chr
authors.initials: C
authors.lastname: Tuxen
authors.forename: Niels
authors.initials: N
authors.lastname: Keller
authors.forename: Jens
authors.initials: J
authors.lastname: Handberg
authors.forename: Anne
authors.initials: A
authors.lastname: Sejr Knudsen
authors.forename: Geert
authors.initials: G
authors.lastname: Espersen
authors.forename: John
authors.initials: J
authors.lastname: Markenvard
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egstrup
authors.forename: Hans
authors.initials: H
authors.lastname: Ulriksen
authors.forename: Per R
authors.initials: PR
authors.lastname: Hildebrandt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002423:Cause of Death; D003325:Coronary Care Units; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D012017:Referral and Consultation; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain