Abstract
BackgroundMulti-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials. However, it is unclear how widely available specialized HF clinics are in Ontario. Also, the service models of current clinics have not been described. It is therefore uncertain whether the efficacy of HF clinics in trials is generalizable to the HF clinics currently operating in the province.MethodsAs part of a comprehensive evaluation of HF clinics in Ontario, we performed an environmental scan to identify all HF clinics operating in 2010. A semi-structured interview was conducted to understand the scope of practice. The intensity and complexity of care offered were quantified through the use of a validated instrument, and clinics were categorized as high, medium or low intensity clinics.ResultsWe identified 34 clinics with 143 HF physicians. We found substantial regional disparity in access to care across the province. The majority of HF physicians were cardiologists (81%), with 81% of the clinics physically based in hospitals, of which 26% were academic centers. There was a substantial range in the complexity of services offered, most notably in the intensity of education and medication management services offered. All the clinics focused on ambulatory care, with only one having an in-patient focus. None of the HF clinics had a home-based component to care.ConclusionsMultiple HF clinics are currently operating in Ontario with a wide spectrum of care models. Further work is necessary to understand which components lead to improved patient outcomes.
Highlights
Multi-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials
It is not known how widely available specialized HF clinics are in Ontario, nor has their composition, or the services they offer, been described
From the initial 15 seed clinics identified through the Canadian Heart Failure Network (CHFN), three generations of snow-ball sampling took place, at which point the sample was saturated
Summary
Multi-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials. The potential benefits of a multi-disciplinary strategy in HF include improved utilization and adherence with evidence-based medications This model of care may address the complex interplay between medical, psychosocial, and behavioural factors facing these patients and their caregivers [3]. Multiple previous randomized studies and metaanalyses have evaluated the efficacy of such clinics with some suggesting a reduction in mortality in excess of 20% [1,3,6]. Interpreting this literature is challenging because of substantial heterogeneity in the composition of the HF clinics, the interventions they offer, and the population studied [3,7]
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