The Status of Specialized Ambulatory Heart Failure Care in Canada: A Joint Canadian Heart Failure Society and Canadian Cardiovascular Society Heart Failure Guidelines Survey

Virani, Sean; Zieroth, Shelley; Bray, Sharon; Ducharme, Anique; Harkness, Karen; Koshman, Sheri L.; McDonald, Michael; O’Meara, Eileen; Swiggum, Elizabeth; Chan, Michael; Giannetti, Nadia; Grzeslo, Adam; Heckman, George A.; Howlett, Jonathan G.; Lepage, Serge; Mielniczuk, Lisa; Moe, Gordon W.; Toma, Mustafa; Abrams, Howard; Al-Hesaye, Abdul; Cohen‐Solal, Alain; D’Astous, Michel; De, Sabe; Delgado, Diego; Desplantie, O.; Estrella-Holder, E.; Green, Lee A.; Haddad, Haissam; Hernandez, Adrian F.; Kouz, Simon; Leblanc, Marie-Hélène; Lee, Douglas S.; Matteau, Sylvain; McKelvie, Robert S.; Parent, Marie-Claude; Ross, Heather J.; Sussex, Bruce

doi:10.1016/j.cjco.2020.03.001

Cited by 11 publications

(19 citation statements)

References 27 publications

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“…A recent national Canadian survey 22 of 45 selected HF clinics (13 from Ontario) demonstrated, similar to our findings, that the majority of clinics provided educational resources, telephone nursing support, and access to cardiac rehabilitation services, followed guideline-directed medication optimization, and counselled on medication adherence, diet, and advanced care planning. Similar to our provincial survey, the criteria for referral acceptance were significantly heterogenous at the national level, an issue leading to inequality in patient care, difficulty in access, and potentially poorer patient outcomes and experience.…”

Section: Discussionsupporting

confidence: 89%

A 2020 Environmental Scan of Heart Failure Clinics in Ontario

et al. 2021

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionsupporting

confidence: 89%

A 2020 Environmental Scan of Heart Failure Clinics in Ontario

et al. 2021

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“…Therefore, there may be some further information on this topic available, which could not be analysed herein. Moreover, an epub on HF clinic processes in Canada was released just before article submission (and hence after the search date) which may also contain further information 65 …”

Section: Discussionmentioning

confidence: 99%

Referral and access to heart function clinics: A realist review

Fowokan

Frankfurter

Dobrow

et al. 2020

Evaluation Clinical Practice

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Rationale, aim, and objectives Heart failure (HF) clinics are highly effective, yet not optimally utilized. A realist review was performed to identify contexts (eg, health system characteristics, clinic capacity, and siting) and underlying mechanisms (eg, referring provider knowledge of clinics and referral criteria, barriers in disadvantaged patients) that influence utilization (provider referral [ie, of all appropriate and no inappropriate patients] and access [ie, patient attends ≥1 visit]) of HF clinics. Methods Following an initial scoping search and field observation in a HF clinic, we developed an initial program theory in conjunction with our expert panel, which included patient partners. Then, a literature search of seven databases was searched from inception to December 2019, including Medline; Grey literature was also searched. Studies of any design or editorials were included; studies regarding access to cardiac rehabilitation, or a single specialist for example, were excluded. Two independent reviewers screened the abstracts, and then full‐texts. Relevant data from included articles were used to refine the program theory. Results A total of 29 papers from five countries (three regions) were included. There was limited information to support or refute many elements of our initial program theory (eg, referring provider knowledge/beliefs, clinic inclusion/exclusion criteria), but refinements were made (eg, specialized care provided in each clinic, lack of patient encouragement). Lack of capacity, geography, and funding arrangements were identified as contextual factors, explaining a range of mechanistic processes, including patient clinical characteristics and social determinants of health as well as clinic characteristics that help to explain inappropriate and low use of HF clinics (outcome). Conclusion Given the burden of HF and benefit of HF clinics, more research is needed to understand, and hence overcome sub‐optimal use of HF clinics. In particular, an understanding from the perspective of referring providers is needed.

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“…Globally, these follow-up programmes provide multidisciplinary care throughout the whole HF spectrum, from de onset through adverse events as hospitalizations or ambulatory treated decompensations, stable phases, and terminal/advanced stages. 16 As the majority of patients are referred to these follow-up programmes after a hospitalization, 23 special focus is usually given to the transition phase, starting in the pre-discharge phase (when discharge is planned, patient education is started, medical therapy is initiated/up-titrated, comorbidities are initially accessed, and a medium-term and long-term plan is drawn) and continuing after discharge (when therapy up-titration is proceeded, adverse events are managed, signs of decompensation are pursued and promptly treated, comorbidities assessment is continued, patient education is reinforced, and doubts and difficulties are addressed). 15 The implementation of these programmes is crucial to ensure that correct diagnostic work-up, use of guideline recommended therapy, and patient education are adequately applied.…”

Section: Discussionmentioning

confidence: 99%

The value of multiparametric prediction scores in heart failure varies with the type of follow‐up after discharge: a comparative analysis

Rodrigues,

Agostinho,

Santos

et al. 2023

ESC Heart Failure

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Aims Multiple prediction score models have been validated to predict major adverse events in patients with heart failure. However, these scores do not include variables related to the type of follow‐up. This study aimed to evaluate the impact of a protocol‐based follow‐up programme of patients with heart failure regarding scores accuracy for predicting hospitalizations and mortality occurring during the first year after hospital discharge. Methods and results Data from two heart failure populations were collected: one composed of patients included in a protocol‐based follow‐up programme after an index hospitalization for acute heart failure and a second one—the control group—composed of patients not included in a multidisciplinary HF management programme after discharge. For each patient, the risk of hospitalization and/or mortality within a period of 12 months after discharge was calculated using four different scores: BCN Bio‐HF Calculator, COACH Risk Engine, MAGGIC Risk Calculator, and Seattle Heart Failure Model. The accuracy of each score was established using the area under the receiver operating characteristic curve (AUC), calibration graphs, and discordance calculation. AUC comparison was established by the DeLong method. The protocol‐based follow‐up programme group included 56 patients, and the control group, 106 patients, with no significant differences between groups (median age: 67 years vs. 68.4 years; male sex: 58% vs. 55%; median ejection fraction: 28.2% vs. 30.5%; functional class II: 60.7% vs. 56.2%, I: 30.4% vs. 31.9%; P = not significant). Hospitalization and mortality rates were significantly lower in the protocol‐based follow‐up programme group (21.4% vs. 54.7%; P < 0.001 and 5.4% vs. 17.9%; P < 0.001, respectively). When applied to the control group, COACH Risk Engine and BCN Bio‐HF Calculator had, respectively, good (AUC: 0.835) and reasonable (AUC: 0.712) accuracy to predict hospitalization. There was a significant reduction of COACH Risk Engine accuracy (AUC: 0.572; P = 0.011) and a non‐significant accuracy reduction of BCN Bio‐HF Calculator (AUC: 0.536; P = 0.1) when applied to the protocol‐based follow‐up programme group. All scores showed good accuracy to predict 1 year mortality (AUC: 0.863, 0.87, 0.818, and 0.82, respectively) when applied to the control group. However, when applied to the protocol‐based follow‐up programme group, a significant predictive accuracy reduction of COACH Risk Engine, BCN Bio‐HF Calculator, and MAGGIC Risk Calculator (AUC: 0.366, 0.642, and 0.277, P < 0.001, 0.002, and <0.001, respectively) was observed. Seattle Heart Failure Model had non‐significant reduction in its acuity (AUC: 0.597; P = 0.24). Conclusions The accuracy of the aforementioned scores to predict major events in patients with heart failure is significantly reduced when they are applied to patients included in a multidisciplinary heart failure management programme.

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The Status of Specialized Ambulatory Heart Failure Care in Canada: A Joint Canadian Heart Failure Society and Canadian Cardiovascular Society Heart Failure Guidelines Survey

Cited by 11 publications

References 27 publications

A 2020 Environmental Scan of Heart Failure Clinics in Ontario

A 2020 Environmental Scan of Heart Failure Clinics in Ontario

Referral and access to heart function clinics: A realist review

The value of multiparametric prediction scores in heart failure varies with the type of follow‐up after discharge: a comparative analysis

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