A new study from the Institute for Clinical Evaluative Sciences (ICES) and THETA (Toronto Health Economics and Technology Assessment) Collaborative shows that multidisciplinary heart failure clinics are associated with a decrease in mortality but an increase in readmissions to hospital.
Heart failure (HF) is a complex, progressive syndrome characterized by abnormal heart function resulting in reductions in both quality of life and survival rates. Delivery models aimed at better control of heart failure have therefore been of particular interest to healthcare professionals and policy-makers alike. The multidisciplinary care model has evolved as the preferred strategy for optimizing patient-centred care and in this context involves a HF physician and nurse at a minimum, but may also include other healthcare professionals, such as pharmacists, home health specialists, therapists and dietitians.
This population-level study compared patients treated at HF clinics to control patients. In addition, the investigators sought to understand which components of HF clinics are associated with improved patient outcomes.
The study found that only approximately 10 per cent of patients discharged alive after a hospitalization for heart failure in Ontario were subsequently seen in specialized multidisciplinary HF clinics and that patients seen in these clinics tended to be younger men with fewer comorbidities. In addition, patients in rural regions had less access to HF clinics.
The study’s lead author, Dr. Harindra Wijeysundera, an ICES scientist and THETA investigator, said that compared to control patients, patients treated at these HF clinics had better rates of survival but an increase in both all-cause and HF-related readmissions.
“Heart failure clinics that had the capacity for more frequent follow up were associated with improvements in mortality and decreased readmissions,” said Wijeysundera, a cardiologist at Schulich Heart Centre, Sunnybrook Health Sciences Centre. “And, those with highly structured algorithms for medication dosage adjustments were also associated with decreases in readmission. However, greater involvement of caregivers, or a more comprehensive education program on supporting self-care, was associated with increased readmission.
”This cohort study of 14,468 patients (of whom 1,288 were seen in HF clinics) discharged after a HF hospitalization from April 1, 2006, to March 31, 2007, compared patients treated in HF clinics using propensity scores to match the control cohort (not treated in HF clinics) and found:
- Within four years of follow-up, 52.1 per cent of HF clinic patients died versus 54.7 per cent of the control group.
- HF clinic patients had increased hospital readmissions.
“A population-based study to evaluate the effectiveness of multidisciplinary heart failure clinics and identify important service components” is available in the journal Circulation: Heart Failure.
Author Block: Harindra C. Wijeysundera, Gina Trubiani, Xuesong Wang, Nicholas Mitsakakis, Peter C. Austin, Dennis T. Ko, Douglas S. Lee, Jack V. Tu, Murray Krahn.
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.
For more information about the THETA collaborative, visit Toronto Health Economics and Technology Assessment (THETA) website.
Toronto Health Economics and Technology Assessment (THETA) Collaborative is a multidisciplinary research collaboration based at the University of Toronto. Established in July 2007, THETA is a leading source of expertise in health technology assessment. It is funded by Health Quality Ontario.
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