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

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.