{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:31:29Z","timestamp":1787959889956,"version":"build-2784847793"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2014,10,14]],"date-time":"2014-10-14T00:00:00Z","timestamp":1413244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100016545","name":"Roche Diagnostics, Basel, Switzerland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>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\u2013III. 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\u20131.97, P = 0.650], a BB (HR 1.09, 95% CI 0.53\u20132.66, P = 0.820), or an MRA (HR 1.30, 95% CI 0.85\u20132.00, P = 0.238).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.176","type":"journal-article","created":{"date-parts":[[2014,10,14]],"date-time":"2014-10-14T06:07:43Z","timestamp":1413266863000},"page":"1249-1255","source":"Crossref","is-referenced-by-count":22,"title":["Effect of Extended Follow-Up in a Specialized Heart Failure Clinic on Adherence to Guideline Recommended Therapy: NorthStar Adherence Study"],"prefix":"10.1093","volume":"16","author":[{"given":"Morten","family":"Schou","sequence":"first","affiliation":[{"name":"Herlev University Hospital , Herlev ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunnar","family":"Gislason","sequence":"additional","affiliation":[{"name":"Gentofte University Hospital , Hellerup ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Videbaek","sequence":"additional","affiliation":[{"name":"Odense University Hospital , Odense C ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Kober","sequence":"additional","affiliation":[{"name":"Rigshospitalet , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Tuxen","sequence":"additional","affiliation":[{"name":"Bispebjerg University Hospital , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Torp-Pedersen","sequence":"additional","affiliation":[{"name":"Aalborg University Hospital , Aalborg C ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per R.","family":"Hildebrandt","sequence":"additional","affiliation":[{"name":"Frederiksberg University Hospital , Frederiksberg ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn","family":"Gustafsson","sequence":"additional","affiliation":[{"name":"Rigshospitalet , Copenhagen ,","place":["Denmark"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2014,10,14]]},"reference":[{"key":"2026011921125935400_ejhf176-bib-0001","first-page":"810","article-title":"Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials","volume":"44","author":"McAlister","year":"2004","journal-title":"J Am Coll Cardiol"},{"key":"2026011921125935400_ejhf176-bib-0002","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.jacc.2009.04.051","article-title":"What is the strength of evidence for heart failure disease-management programs?","volume":"54","author":"Clark","year":"2009","journal-title":"J Am Coll Cardiol"},{"key":"2026011921125935400_ejhf176-bib-0003","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1093\/eurjhf\/hfs105","article-title":"ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. 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