title: Multidisciplinary outpatient congestive heart failure clinic: impact on hospital admissions and emergency room visits.
abstract: BACKGROUND
  Life-saving drugs, such as angiotensin-converting enzyme inhibitors and beta-blockers, are frequently underused and underdosed in patients with heart failure. Specialized clinics have been shown to provide additional benefits.
  
  
  OBJECTIVE
  To determine the impact of a multidisciplinary outpatient heart failure clinic on the frequency of cardiovascular readmissions and emergency room (ER) visits, length of inpatient and ER stays, and New York Heart Association (NYHA) class.
  
  
  METHODS
  A retrospective chart review study comprising 72 patients who had two or more visits to a heart failure clinic between December 1, 1998, and August 31, 1999, was performed. The number of readmissions and ER visits, and the NYHA class were recorded during the six-month period before and after the first visit to the clinic.
  
  
  RESULTS
  Most subjects were in NYHA class III or IV (71% and 21%, respectively), and the mean ejection fraction was 31%. The post- versus preintervention relative risk of readmission was 0.43 (95% CI 0.25 to 0.72). The total number of inpatient days decreased by 54% (95% CI 44% to 62%). The post- versus preintervention relative risk of an ER visit was 0.29 (95% CI 0.19 to 0.45). The number of ER days decreased by 60% (95% CI 41% to 73%). NYHA functional class significantly improved, with most subjects ending the six-month postintervention period in class I or II (33% and 49%, respectively; P=0.001).
  
  
  CONCLUSIONS
  This multidisciplinary heart failure clinic significantly decreased the risk of cardiovascular readmissions and subsequent ER visits. It led to improvement in NYHA class and to a decrease in the number of days spent in the hospital and in the ER.
authors.affiliation: Hôpital du Sacré-Coeur de Montréal and Faculté de Pharmacie, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Martineau
authors.forename: Marc
authors.initials: M
authors.lastname: Frenette
authors.forename: Lucie
authors.initials: L
authors.lastname: Blais
authors.forename: Claude
authors.initials: C
authors.lastname: Sauvé
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000592:standards* / Q000706:statistics & numerical data; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011336:Probability; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D017749:Total Quality Management; D016896:Treatment Outcome; D014600:Utilization Review
chemical_list: D002316:Cardiotonic Agents