title: Long-term follow-up in optimally treated and stable heart failure patients: primary care vs. heart failure clinic. Results of the COACH-2 study.
abstract: OBJECTIVE
  It has been suggested that home-based heart failure (HF) management in primary care may be an alternative to clinic-based management in HF patients. However, little is known about adherence to HF guidelines and adherence to the medication regimen in these home-based programmes. The aim of the current study was to determine whether long-term follow-up and treatment in primary care is equally effective as follow-up at a specialized HF clinic in terms of guideline adherence and patient adherence, in HF patients initially managed and up-titrated to optimal treatment at a specialized HF clinic.
  
  
  RESULTS
  We conducted a multicentre, randomized, controlled study in 189 HF patients (62% male, age 72 ± 11 years), who were assigned to follow-up either in primary care (n = 97) or in a HF clinic (n = 92). After 12 months, no differences between guideline adherence, as estimated by the Guideline Adherence Indicator (GAI-3), and patient adherence, in terms of the medication possession ratio (MPR), were found between treatment groups. There was no difference in the number of deaths (n = 12 in primary care and n = 8 in the HF clinic; P = 0.48), and hospital readmissions for cardiovascular (CV) reasons were also similar. The total number of unplanned non-CV hospital readmissions, however, tended to be higher in the primary care group (n = 22) than in the HF clinic group (n = 10; P = 0.05).
  
  
  CONCLUSIONS
  Patients discharged after initial management in a specialized HF clinic can be discharged to primary care for long-term follow-up with regard to maintaining guideline adherence and patient adherence. However, the complexity of the HF syndrome and its associated co-morbidities requires continuous monitoring. Close collaboration between healthcare providers will be crucial in order to provide HF patients with optimal, integrated care.
authors.affiliation: Department of Cardiology, University Medical Center Groningen/University of Groningen, the Netherlands.
authors.forename: Marie Louise A
authors.initials: ML
authors.lastname: Luttik
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Peter Paul
authors.initials: PP
authors.lastname: van Geel
authors.forename: Maaike
authors.initials: M
authors.lastname: Brons
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Arno W
authors.initials: AW
authors.lastname: Hoes
authors.forename: Richard
authors.initials: R
authors.lastname: de Jong
authors.forename: Gerard
authors.initials: G
authors.lastname: Linssen
authors.forename: Dirk J A
authors.initials: DJ
authors.lastname: Lok
authors.forename: Marjolein
authors.initials: M
authors.lastname: Berge
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011320:Primary Health Care / Q000592:standards*; D016896:Treatment Outcome
keywords: Adherence; Disease management; Heart failure; Primary care