Do Heart Failure Clinics Have to Reinvent Themselves to Remain Germane?

Ducharme, Anique

doi:10.1016/j.cjca.2017.07.003

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…In most studies, the overwhelming trend observed was that younger individuals with HF were more often represented in the HF clinics. In Canada, it was observed that older and more frail patients who perhaps might be better served in those clinics 55 utilized them less; this difference was particularly pronounced in older patients living in rural areas 23,31 . Similar findings were reported in Quebec 33,35 and Nova Scotia, 36 where it was found that patients who utilized HF clinics were relatively younger.…”

Section: Resultssupporting

confidence: 58%

“…The average percentage of women accessing these clinics was 35.5%, ranging from 26% to 41% across the clinics, 27 which seems disproportionate given the high prevalence of HF in women 27,35,52 . This pattern was also observed in other parts of Canada as well 31‐33,35,36 . In the United States, similarly Akosah et al found that 71% of men were referred to HF clinics 28 .…”

Section: Resultsmentioning

confidence: 86%

“…Another Ontario study reported that having lower ejection fraction (EF), and lower functional status were associated with HF clinic use 16 . Similarly, an evaluation of Canada‐wide clinics also found that referred patients had fewer comorbidities 23,31 . In Quebec clinics, factors associated with referral to an HF clinic at an earlier point in the disease trajectory included lower New York Heart Association (NYHA) functional class, and having no diabetes or chronic renal insufficiency 32 .…”

Section: Resultsmentioning

confidence: 97%

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Referral and access to heart function clinics: A realist review

Fowokan

Frankfurter

Dobrow

et al. 2020

Evaluation Clinical Practice

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Rationale, aim, and objectives Heart failure (HF) clinics are highly effective, yet not optimally utilized. A realist review was performed to identify contexts (eg, health system characteristics, clinic capacity, and siting) and underlying mechanisms (eg, referring provider knowledge of clinics and referral criteria, barriers in disadvantaged patients) that influence utilization (provider referral [ie, of all appropriate and no inappropriate patients] and access [ie, patient attends ≥1 visit]) of HF clinics. Methods Following an initial scoping search and field observation in a HF clinic, we developed an initial program theory in conjunction with our expert panel, which included patient partners. Then, a literature search of seven databases was searched from inception to December 2019, including Medline; Grey literature was also searched. Studies of any design or editorials were included; studies regarding access to cardiac rehabilitation, or a single specialist for example, were excluded. Two independent reviewers screened the abstracts, and then full‐texts. Relevant data from included articles were used to refine the program theory. Results A total of 29 papers from five countries (three regions) were included. There was limited information to support or refute many elements of our initial program theory (eg, referring provider knowledge/beliefs, clinic inclusion/exclusion criteria), but refinements were made (eg, specialized care provided in each clinic, lack of patient encouragement). Lack of capacity, geography, and funding arrangements were identified as contextual factors, explaining a range of mechanistic processes, including patient clinical characteristics and social determinants of health as well as clinic characteristics that help to explain inappropriate and low use of HF clinics (outcome). Conclusion Given the burden of HF and benefit of HF clinics, more research is needed to understand, and hence overcome sub‐optimal use of HF clinics. In particular, an understanding from the perspective of referring providers is needed.

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Section: Resultssupporting

confidence: 58%

Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 97%

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Referral and access to heart function clinics: A realist review

Fowokan

Frankfurter

Dobrow

et al. 2020

Evaluation Clinical Practice

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“…With the general lack of coordination in patient care, HF patients may find it difficult to access HFCs. Thus, more rural regions may have more limited access to clinics compared with other regions 68 . Additionally, many HF patients are frail and may have transportation problems, which render attending scheduled visits harder and compromises established follow‐up plans.…”

Section: Resultsmentioning

confidence: 99%

Current status of outpatient heart failure management in Egypt and recommendations for the future

Hassanein,

Tageldien,

Badran

et al. 2023

ESC Heart Failure

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Heart failure (HF) represents one of the greatest healthcare burdens worldwide, and Egypt is no exception. HF healthcare programmes in Egypt still require further optimization to enhance diagnosis and management of the disease. Development of specialized HF clinics (HFCs) and their incorporation in the healthcare system is expected to reduce HF hospitalization and mortality rates and improve quality of care in Egypt. We conducted a literature search on PubMed on the requirements and essential infrastructure of HFCs. Retrieved articles deemed relevant were discussed by a panel of 10 expert cardiologists from Egypt and a basic HFC model for the Egyptian settings was proposed. A multidisciplinary team managing the HFC should essentially be composed of specialized HF cardiologists and nurses, clinical pharmacists, registered nutritionists, physiotherapists, and psychologists. Other clinical specialists should be included according to patients' needs and size and structure of individual clinics. HFCs should receive patients referred from primary care settings, emergency care units, and physicians from different specialties. A basic HFC should have the following fundamental investigations available: resting electrocardiogram, basic transthoracic echocardiogram, and testing for N‐terminal pro‐B‐type natriuretic peptide. Fundamental patients' functional assessments are assessing the New York Heart Association functional classification and quality of life and conducting the 6 min walking test. guideline‐directed medical therapy should be implemented, and device therapy should be utilized when available. In the first visit, once HF is diagnosed and co‐morbidities assessed, guideline‐directed medical therapy should be started immediately. Comprehensive patient education sessions should be delivered by HF nurses or clinical pharmacists. The follow‐up visit should be scheduled during the initial visit rather than over the phone, and time from the initial visit to the first follow‐up visit should be determined based on the patient's health status and needs. Home and virtual visits are only recommended in limited and emergency situations. In this paper, we provide a practical and detailed review on the essential components of HFCs and propose a preliminary model of HFCs as part of a comprehensive HF programme model in Egypt. We believe that other low‐to‐middle income countries could also benefit from our proposed model.

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“…Its prevalence increases with age, reaching up to 20 % over the age of 75 years [3] , a proportion expected to increase due to the aging population . The majority presents with mild symptoms (NYHA functional class II) [2] , and is being followed by primary care providers (PCP) in the community [4] .…”

Section: Introductionmentioning

confidence: 99%

Clinical Heart fAilure Management Program: Changing the practice by partnering primary care and specialists (CHAMP-HF)

Parent,

Leclerc,

O'Meara

et al. 2024

IJC Heart & Vasculature

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Do Heart Failure Clinics Have to Reinvent Themselves to Remain Germane?

Cited by 6 publications

References 26 publications

Referral and access to heart function clinics: A realist review

Referral and access to heart function clinics: A realist review

Current status of outpatient heart failure management in Egypt and recommendations for the future

Clinical Heart fAilure Management Program: Changing the practice by partnering primary care and specialists (CHAMP-HF)

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