Implementation of guidelines for management of heart failure in heart failure clinic: effects beyond pharmacological treatment.

BACKGROUND: Patients with heart failure have scarce knowledge of their condition and frequently report poor quality of life. In spite of numerous studies showing improvement of survival and reduction in hospitalizations, several epidemiological studies showed that substantial proportion of patients are not receiving appropriate treatment. Intensive multidisciplinary approach can improve management of the patients with heart failure. AIM: To assess the efficacy of intensive patient management in heart failure clinic with respect to patient knowledge, pharmacological management, and quality of life.
METHODS: From outpatients, visiting the heart failure clinic in period form March 2002 to March 2003, we prospectively enrolled patients with heart failure due to systolic dysfunction. Patient knowledge about their condition was assessed by a knowledge questionnaire. Data on their clinical characteristics, diagnostic and pharmacological management were analyzed. Quality of life was assessed with Minnesota Living with Heart Failure Questionnaire (MLHFQ). Patients rated their quality of life and heath on a seven-category descriptive scale from 1 (best) to 7 (worst). Data are shown as mean (S.D.).
RESULTS: In this period we treated 50 patients (33 men), aged 67 (12) years. Patient knowledge about their condition improved after two visits to heart failure clinic (4.8 (1.5) vs. 7.3 (1.4), p<0.001). More patients were treated with beta blockers (40% vs. 84%, p<0.001) while there was a positive trend for treatment with angiotensin-converting enzyme inhibitors (94% vs. 98%) and spironolactone (54% vs. 70%). Equivalent mean daily dose of enalapril (11.0 (11.0) mg to 16.7 (8.7) mg, p<0.001) and carvedilol (13.0 (11.5) mg to 32.1 (18.2) mg, p<0.001) increased. Out-patient management was associated with improvement of MLHFQ score (47 (18) vs. 34 (16)), NYHA class (2.9 (0.4) vs. 2.5 (0.7)), quality of life score (5.3 (1.1) vs. 3.7 (1.0)), and health score (5.1 (1.1) vs. 3.7 (1.1)) (p<0.001 for all).
CONCLUSIONS: Intensive management in heart failure clinic can be effective for translation of guidelines into clinical practice. It also improves patient's knowledge and quality of life as well as reduces the hospitalizations in heart failure patients.