AimsIt 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. Methods and resultsWe 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). Conclusionsless thanp id="ejhf173-para-0003"greater thanPatients 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.

Funding Agencies|Netherlands Heart Foundation (NHF) [2008B083]

Background Since the number of heart failure (HF) patients is still growing and long-term treatment of HF patients is necessary, it is important to initiate effective ways for structural involvement of primary care services in HF management programs. However, evidence on whether and when patients can be referred back to be managed in primary care is lacking. Aim To determine whether long-term patient management in primary care, after initial optimisation of pharmacological and non-pharmacological treatment in a specialised HF clinic, is equally effective as long-term management in a specialised HF clinic in terms of guideline adherence and patient compliance. Method The study is designed as a randomised, controlled, non-inferiority trial. Two-hundred patients will be randomly assigned to be managed and followed in primary care or in a HFclinic. Patients are eligible to participate if they are (1) clinically stable, (2) optimally up-titrated on medication (according to ESC guidelines) and, (3) have received optimal education and counselling on pre-specified issues regarding HF and its treatment. Furthermore, close cooperation between secondary and primary care in terms of back referral to or consultation of the HF clinic will be provided.The primary outcome will be prescriber adherence and patient compliance with medication after 12 months. Secondary outcomes measures will be readmission rate, mortality, quality of life and patient compliance with other lifestyle changes. Expected results The results of the study will add to the understanding of the role of primary care and HF clinics in the long-term follow-up of HF patients.

A MEMS microphone array has been designed and applied to the measurement of wall pressure spectra under the turbulent boundary layer in flow duct testing at Mach numbers from 0 to 0.6. The array was micromachined onto a single chip in the PolyMUMPS surface micromachining process, allowing high spatial resolution and low surface roughness. The chip measures 1 cm by 1 cm, and is flush mounted into the wind tunnel wall. Individual elements are 0.6 mm in diameter, with element to element spacing of 1.11 mm in the crossflow direction and 1.26 mm in the flow direction. The 64 element array has 59 working elements, 58 of which are matched to within ± 2.5 dB at 1 kHz. Phase matching between the 59 elements is ± 6.5 degrees at 1 kHz. The array has been calibrated from 100 Hz to 4 kHz in a plane wave tube. The transducer bandwidth is greater than 400 kHz as determined by laser vibrometry measurements. Sensor nonlinearity of less than 0.36% is observed at a sound pressure level of 150 dB SPL. Board level electronics allow the array to be reconfigured on the fly using computer controlled CMOS switches. Multipoint wall pressure spectra were measured in 38 array configurations at the wall of a 6 inch by 6 inch flow duct at Mach numbers from 0.0 to 0.6. The array shows excellent agreement with Kulite and Bruel & Kjaer microphone measurements in the 300 Hz to 10 kHz band, and appears to be able to measure turbulent pressure spectra at frequencies as high as 40 kHz.

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The design, fabrication, and characterization of a surface micromachined, front-vented, 64 channel (8×8), capacitively sensed pressure sensor array is described. The array was fabricated using the MEMSCAP PolyMUMPs® process, a three layer polysilicon surface micromachining process. An acoustic lumped element circuit model was used to design the system. The results of our computations for the design, including mechanical components, environmental loading, fluid damping, and other acoustic elements are detailed. Theory predicts single element sensitivity of 1 mV/Pa at the gain stage output in the 400–40,000 Hz band. A laser Doppler velocimetry (LDV) system has been used to map the spatial motion of the elements in response to electrostatic excitation. A strong resonance appears at 480 kHz for electrostatic excitation, in good agreement with mathematical models. Static stiffness measured electrostatically using an interferometer is 0.1 nm/V2, similar to the expected stiffness. Preliminary acoustic sensitivity studies show single element acoustic sensitivity (as a function of frequency) increasing from 0.01 mV/Pa at 200 Hz to 0.16 mV/Pa at 2 kHz. A more in depth analysis of acoustic sensitivity is ongoing.