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Insights into the contemporary management of heart failure in specialized multidisciplinary ambulatory clinics
Lusine Abrahamyan1, Gina Trubiani, William Witteman
1Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada.
Insights
Heart failure clinics show significant variation in patient profiles, treatments, and referrals. Standardizing care across specialized heart failure (HF) clinics is crucial for evidence-based patient management.
Area of Science:
- Cardiology
- Health Services Research
Background:
- Heart failure (HF) clinics improve outcomes in trials.
- Real-world HF clinic models exhibit significant heterogeneity.
- Ontario, Canada has 34 HF clinics.
Purpose of the Study:
- Evaluate the impact of clinic-level heterogeneity on HF patient management.
- Assess variations in care delivery within Ontario HF clinics.
Main Methods:
- Randomly selected 9 out of 34 HF clinics in Ontario (2011).
- Abstracted ~100 patient charts per clinic (total 900).
- Collected data on demographics, comorbidities, diagnostics, medications, and referrals.
Main Results:
- Observed significant heterogeneity in patient profiles, therapies, diagnostics, personnel, and referrals.
- Patient age varied significantly between clinics (mean 66.1 ± 15.7 years).
- Echocardiography use ranged from 42%-94%; cardiac rehab referral was low (10.4% overall, 1%-28% variation).
Conclusions:
- Specialized HF clinics demonstrate wide variation in staffing and care processes.
- Significant differences exist in patient clinical characteristics across HF clinics.
- Province-wide strategies are needed to standardize HF management for evidence-based care.
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.
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