title: Improving Heart Failure Outcomes in Ambulatory and Community Care: A Scoping Study.
abstract: Despite a large body of literature testing interventions to improve heart failure care, care is often suboptimal. This scoping study assesses organizational interventions to improve heart failure outcomes in ambulatory settings. Fifty-two studies and systematic reviews assessing multicomponent, self-management support, and eHealth interventions were included. Studies dating from the 1990s demonstrated that multicomponent interventions could reduce hospitalizations, readmissions, mortality, and costs and improve quality of life. Self-management support appeared more effective when included in multicomponent interventions. The independent contribution of eHealth interventions remains unclear. No studies addressed management of comorbidities, geriatric syndromes, frailty, or end of life care. Few studies addressed risk stratification or vulnerable populations. Limited reporting about intervention components, implementation methods, and fidelity presents challenges in adapting this literature to scale interventions. The use of standardized reporting guidelines and study designs that produce more contextual evidence would better enable application of this work in health system redesign.
authors.affiliation: 2 Niagara Health System, Ontario, Canada.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Jensen
authors.affiliation: 1 University of Toronto, Ontario, Canada.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Troster
authors.affiliation: 1 University of Toronto, Ontario, Canada.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Cai
authors.affiliation: 3 Ben-Gurion University of the Negev, Beersheba, Israel.
authors.forename: Avram
authors.initials: A
authors.lastname: Shack
authors.affiliation: 4 University College Cork, Cork, Ireland.
authors.forename: Ying-Ju Ruby
authors.initials: YR
authors.lastname: Chang
authors.affiliation: 5 Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Dorothy
authors.initials: D
authors.lastname: Wang
authors.affiliation: 6 Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Ji Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: 1 University of Toronto, Ontario, Canada.
authors.forename: Diva
authors.initials: D
authors.lastname: Turial
authors.affiliation: 1 University of Toronto, Ontario, Canada.|7 St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Bierman
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D003153:Community Health Services / Q000458:organization & administration*; D019468:Disease Management; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D012648:Self Care
keywords: ambulatory care; disease management; heart failure; primary health care; quality improvement