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A population-based study to evaluate the effectiveness of multi-disciplinary heart failure clinics and identify important service components

Wijeysundera HC, Trubiani G, Wang X, Mitsakakis N, Austin PC, Ko DT, Lee DS, Tu JV, Krahn M. Circ Heart Fail. 2013; 6(1):68-75. Epub 2012 Dec 10.

Background — Multi-disciplinary heart failure (HF) clinics are efficacious in clinical trials. The researchers’ objectives were to compare real-world outcomes of HF patients treated in HF clinics vs. usual therapy and identify HF clinic features associated with improved outcomes.

Methods and Results — The service components at all HF clinics in Ontario, Canada were quantified using a validated instrument and categorized as high/medium/low intensity. The researchers used propensity scores to match HF clinic and control patients discharged alive after a HF readmission in 2006-07. Outcomes were mortality, and both all-cause and HF readmission. Cox-proportional hazard models were used to evaluate HF clinic level characteristics associated with improved outcomes. The researchers identified 14,468 HF patients, of whom 1,288 were seen in HF clinics. With 4 years of follow-up, 52.1% of HF clinic patients died versus 54.7% of control patients (p-value 0.02). HF clinic patients had increased readmissions (87.4% vs. 86.6% for all-cause [p-value 0.009]; 58.7% vs. 47.3% for HF-related [p-value <0.001]). There was no difference between high, medium or low intensity clinics in terms of mortality, all-cause or HF readmissions. HF Clinics with greater frequency of visits (> 4 contacts of significant duration over 6 months) were associated with lower mortality (HR 0.14; p-value <0.0001) and hospitalization (HR 0.69; p-value 0.039). More intensive medication management was associated with lower all-cause (HR 0.46; p-value <0.001) and HF readmission (HR 0.42; p-value <0.001).

Conclusions — In this real-world population based study, the researchers found that multi-disciplinary HF clinics are associated with a decrease in mortality but increase in readmissions.

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Keywords: Ambulatory care Cardiovascular diseases Treatment outcomes