title: Effect of extended follow-up in a specialized heart failure clinic on adherence to guideline recommended therapy: NorthStar Adherence Study.
abstract: OBJECTIVE
  The optimal duration of a public heart failure (HF) clinic programme is unknown. This substudy of the NT-proBNP stratified follow-up in outpatient heart failure clinics (NorthStar) trial was designed to evaluate the effect of extended follow-up in an outpatient HF clinic on long-term adherence to guideline-based therapy.
  
  
  RESULTS
  Patients with HF with reduced EF on optimal medical therapy (n = 921) were randomized to either extended follow-up in the HF clinic (n = 461) or discharge to primary care (n = 460) and followed for a median of 4.1 years (range: 13 months to 6.1 years). The effect of the HF clinic intervention on treatment adherence (time to at least a 90 day break in treatment) was estimated by drug dispensing from pharmacies of an ACE inhibitor/ARB, beta-blocker (BB), or mineralocorticoid receptor antagonist (MRA). Median age was 69 years, 25% were females, LVEF was 30%, and 90% were in NYHA class II-III. The HF clinic intervention did not reduce time to a 90 day break in treatment with either an ACE inhibitor/ARB [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.34-1.97, P = 0.650], a BB (HR 1.09, 95% CI 0.53-2.66, P = 0.820), or an MRA (HR 1.30, 95% CI 0.85-2.00, P = 0.238).
  
  
  CONCLUSIONS
  Extended follow-up in an outpatient HF clinic did not improve long-term adherence to guideline-based therapy, and adherence did not deteriorate when follow-up was shifted from the HF clinic to primary care.
authors.affiliation: Herlev University Hospital, Herlev, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.forename: Gunnar
authors.initials: G
authors.lastname: Gislason
authors.forename: Lars
authors.initials: L
authors.lastname: Videbaek
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
authors.forename: Christian
authors.initials: C
authors.lastname: Tuxen
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Per R
authors.initials: PR
authors.lastname: Hildebrandt
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards*; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Adherence; Angiotensin-converting enzyme inhibitor; Beta-blocker; Heart failure clinic; Mineralocorticoid receptor antagonist; Systolic heart failure