A Population-Based Study to Evaluate the Effectiveness of Multidisciplinary Heart Failure Clinics and Identify Important Service Components

作者：Wijeysundera Harindra C^*; Trubiani Gina; Wang Xuesong; Mitsakakis Nicholas; Austin Peter C; Ko Dennis T; Lee Douglas S; Tu Jack V; Krahn Murray

来源：Circulation-Heart Failure, 2013, 6(1): 68-+.

DOI：10.1161/CIRCHEARTFAILURE.112.971051

• health outcomes
• heart failure
• multidisciplinary clinic

Background-Multidisciplinary heart failure (HF) clinics are efficacious in clinical trials. Our objectives were to compare real-world outcomes of patients with HF treated in HF clinics versus 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. We used propensity-scores to match HF clinic and control patients discharged alive after a HF readmission in 2006-2007. 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. We identified 14 468 patients with HF, of whom 1288 were seen in HF clinics. Within 4 years of follow-up, 52.1% of patients treated at a HF clinic died versus 54.7% of control patients (P=0.02). Patients treated at HF clinics had increased readmissions (87.4% versus 86.6% for all-cause [P=0.009]; 58.7% versus 47.3% for HF related [P<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 for 6 months) were associated with lower mortality (hazard ratio, 0.14; P<0.0001) and hospitalization (hazard ratio, 0.69; P=0.039). More intensive medication management was associated with lower all-cause (hazard ratio, 0.46; P<0.001) and HF readmission (hazard ratio, 0.42; P<0.001).
Conclusions-In this real-world population-based study, we found that multidisciplinary HF clinics are associated with a decrease in mortality, but an increase in readmissions.

• 出版日期2013-1