title: Specialized multi-disciplinary heart failure clinics in Ontario, Canada: an environmental scan.
abstract: BACKGROUND
  Multi-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials. However, it is unclear how widely available specialized HF clinics are in Ontario. Also, the service models of current clinics have not been described. It is therefore uncertain whether the efficacy of HF clinics in trials is generalizable to the HF clinics currently operating in the province.
  
  
  METHODS
  As part of a comprehensive evaluation of HF clinics in Ontario, we performed an environmental scan to identify all HF clinics operating in 2010. A semi-structured interview was conducted to understand the scope of practice. The intensity and complexity of care offered were quantified through the use of a validated instrument, and clinics were categorized as high, medium or low intensity clinics.
  
  
  RESULTS
  We identified 34 clinics with 143 HF physicians. We found substantial regional disparity in access to care across the province. The majority of HF physicians were cardiologists (81%), with 81% of the clinics physically based in hospitals, of which 26% were academic centers. There was a substantial range in the complexity of services offered, most notably in the intensity of education and medication management services offered. All the clinics focused on ambulatory care, with only one having an in-patient focus. None of the HF clinics had a home-based component to care.
  
  
  CONCLUSIONS
  Multiple HF clinics are currently operating in Ontario with a wide spectrum of care models. Further work is necessary to understand which components lead to improved patient outcomes.
authors.affiliation: Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada. wijeysundera@gmail.com
authors.forename: Harindra C
authors.initials: HC
authors.lastname: Wijeysundera
authors.forename: Gina
authors.initials: G
authors.lastname: Trubiani
authors.forename: Lusine
authors.initials: L
authors.lastname: Abrahamyan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mitsakakis
authors.forename: William
authors.initials: W
authors.lastname: Witteman
authors.forename: Mike
authors.initials: M
authors.lastname: Paulden
authors.forename: Gabrielle
authors.initials: G
authors.lastname: van der Velde
authors.forename: Kori
authors.initials: K
authors.lastname: Kingsbury
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D003151:Community Health Centers / Q000191:economics / Q000458:organization & administration*; D005380:Financing, Government; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D009864:Ontario / Q000453:epidemiology; D011785:Quality Assurance, Health Care