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

Circ Heart Fail. 2013 Jan;6(1):68-75. doi: 10.1161/CIRCHEARTFAILURE.112.971051. Epub 2012 Dec 10.


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.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Community Health Centers / organization & administration*
  • Female
  • Follow-Up Studies
  • Heart Failure / epidemiology
  • Heart Failure / therapy*
  • Humans
  • Length of Stay / statistics & numerical data*
  • Male
  • Morbidity / trends
  • Ontario / epidemiology
  • Patient Admission / statistics & numerical data*
  • Quality Assurance, Health Care / trends*
  • Registries*
  • Retrospective Studies