Article

Referral and use of heart failure clinics: what factors are related to use?

York University, Faculty of Health, Toronto, Ontario, Canada.
The Canadian journal of cardiology (Impact Factor: 3.12). 02/2012; 28(4):483-9. DOI: 10.1016/j.cjca.2011.11.020
Source: PubMed

ABSTRACT Heart failure (HF) clinics have been shown to reduce hospital readmissions and generally have favourable effects on quality of life, survival, and care costs. This study investigated the rates of referral and use of HF clinics and examined factors related to program use.
This study represents a secondary analysis of a larger prospective cohort study conducted in Ontario. In hospital, 474 HF inpatients from 11 hospitals across Ontario completed a survey that examined predisposing, enabling, and need factors affecting HF clinic use. Then 1 year later, 271 HF patients completed a mailed survey that assessed referral to and use of HF clinics.
Forty-one patients (15.2%) self-reported referral, and 35 (13%) self-reported attending an HF clinic. Generalized estimating equations showed that factors related to greater program use were having an HF clinic at the site of hospital recruitment (odds ratio [OR] = 8.40; P = 0.04), referral to other disease management programs (OR = 4.87; P = 0.04), higher education (OR = 4.61; P = 0.02), lower stress (OR = 0.93; P = 0.03), and lower functional status (OR = 0.97; P = 0.03).
Similar to previous research, only one-seventh of HF patients were referred to and used an HF clinic. Both patient-level and health-system factors were related to HF clinic use. Given the benefits of HF clinics, more research examining how equitable access can be increased is needed. Also, the appropriateness and cost repercussions of use of multiple disease management programs should be investigated.

0 Bookmarks
 · 
96 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The widespread acceptance of heart-failure (HF) clinics is based on studies with poor and poorly-described care. This led to HF-clinic proliferation, often with access for a small percentage of younger, healthier and generally affluent patients. This system fails to provide the essential timely access to specialist-team consultation following hospital-discharge. Recent well-conducted randomized trials of HF-clinic care found no benefit over usual care. To provide optimal value, HF-clinics must evolve to devote resources to timely assessment/reassessment and close follow-up of selected high-risk/advanced HF patients, along with timely support of the primary-care team that will assure the bulk of routine HF care.
    The Canadian journal of cardiology 03/2014; 30(3):276-80. · 3.12 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Heart failure (HF) clinics are associated with improved outcomes in randomized trials, however, there is substantial heterogeneity in the service models of HF clinics in practice. Our objective was to evaluate the effect of this clinic level heterogeneity on HF patient management in Ontario, Canada. METHODS: Charts were abstracted from 9 HF clinics, chosen at random from the 34 HF clinics in operation in Ontario in 2011. From each clinic, approximately 100 patient charts were randomly selected for detailed abstraction on patient demographic characteristics, comorbidities, diagnostic tests, medication use, and referrals, over a 1-year period from the first clinic visit. RESULTS: Significant heterogeneity was observed in patient baseline profiles, pharmacological therapies, diagnostic testing, clinic personnel, and referrals across 9 clinics. The mean age of patients was 66.1 ± 15.7 years and was significantly different between the clinics. Most patients were male (65%), and mean left ventricular ejection fraction was 33%. There was significant variation in the utilization of echocardiography (42%-94%) and coronary angiography (19%-62%). Overall, approximately 88% of patients were prescribed angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, and 85% were prescribe β-blockers. The rates of referral to cardiac rehabilitation programs were overall low at 10.4% of patients, with substantial variation (1%-28%). CONCLUSIONS: Specialized HF clinics have wide variation in the health personnel involved and the care provided; in addition, patients treated at these HF clinics have important differences in clinical characteristics. Strategies should be considered at the appropriate level (eg, province-wide in Ontario) to standardize HF management and provide best evidence-based care to patients.
    The Canadian journal of cardiology 04/2013; · 3.12 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Heart failure (HF) clinics have had an important role in optimal HF management and the effectiveness of these clinics has been studied intensively. A HF clinic is one of the various ways to organize a HF disease management program. There is good evidence that HF disease management can improve outcomes in HF patients, but it is not clear what the optimal components of these programs are and what the relative effectiveness of a HF clinic is compared with other forms of HF management. After initial positive reports on the effect of HF clinics, these clinics were implemented in many countries, although in different formats and of varying quality. In this article we describe the initial need for HF clinics, reflect on their development over time, and discuss the role of HF clinics in context of the current need for HF disease management.
    The Canadian journal of cardiology 01/2014; · 3.12 Impact Factor