title: A population-based study to evaluate the effectiveness of multidisciplinary heart failure clinics and identify important service components.
abstract: 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.
  
  
  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.
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: Xuesong
authors.initials: X
authors.lastname: Wang
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mitsakakis
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.forename: Dennis T
authors.initials: DT
authors.lastname: Ko
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000368:Aged; D003151:Community Health Centers / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009017:Morbidity / Q000639:trends; D009864:Ontario / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies