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Mamataz T, Virani SA, McDonald M, Edgell H, Grace SL. Heart failure clinic inclusion and exclusion criteria: cross-sectional study of clinic's and referring provider's perspectives. BMJ Open 2024; 14:e076664. [PMID: 38485484 PMCID: PMC10941180 DOI: 10.1136/bmjopen-2023-076664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES There are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF clinic inclusion or exclusion criteria and how that related to referring providers' perspectives of ideal criteria. DESIGN, SETTING AND PARTICIPANTS Two cross-sectional surveys were administered via research electronic data capture to clinic providers and referrers (eg, cardiologists, family physicians and nurse practitioners) across Canada. MEASURES Twenty-seven criteria selected based on the literature and HF guidelines were tested. Respondents were asked to list any additional criteria. The degree of agreement was assessed (eg, Kappa). RESULTS Responses were received from providers at 48 clinics (37.5% response rate). The most common actual inclusion criteria were newly diagnosed HF with reduced or preserved ejection fraction, New York Heart Association class IIIB/IV and recent hospitalisation (each endorsed by >74% of respondents). Exclusion criteria included congenital aetiology, intravenous inotropes, a lack of specialists, some non-cardiac comorbidities and logistical factors (eg, rurality and technology access). There was the greatest discordance between actual and ideal criteria for the following: inpatient at the same institution (κ=0.14), congenital heart disease, pulmonary hypertension or genetic cardiomyopathies (all κ=0.36). One-third (n=16) of clinics had changed criteria, often for non-clinical reasons. Seventy-three referring providers completed the survey. Criteria endorsed more by referrers than clinics included low blood pressure with a high heart rate, recurrent defibrillator shocks and intravenous inotropes-criteria also consistent with guidelines. CONCLUSIONS There is considerable agreement on the main clinic entry criteria, but given some discordance, two levels of clinics may be warranted. Publicising evidence-based criteria and applying them systematically at referral sources could support improved HF patient care journeys and outcomes.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
| | - Sean A Virani
- Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Michael McDonald
- Peter Munk Cardiac Centre, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Heather Edgell
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Keele Campus, Toronto, Ontario, Canada
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Mamataz T, Lee DS, Turk-Adawi K, Hajaj A, Code J, Grace SL. Factors Affecting Healthcare Provider Referral to Heart Function Clinics: A Mixed-Methods Study. J Cardiovasc Nurs 2024; 39:18-30. [PMID: 37669639 DOI: 10.1097/jcn.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND Heart failure (HF) care providers are gatekeepers for patients to appropriately access lifesaving HF clinics. OBJECTIVE The aim of this study was to investigate referring providers' perceptions regarding referral to HF clinics, including the impact of provider specialty and the coronavirus disease pandemic. METHODS An exploratory, sequential design was used in this mixed-methods study. For the qualitative stage, semistructured interviews were performed with a purposive sample of HF providers eligible to refer (ie, nurse practitioners, cardiologists, internists, primary care and emergency medicine physicians) in Ontario. Interviews were conducted via Microsoft Teams. Transcripts were analyzed concurrently by 2 researchers independently using NVivo, using a deductive-thematic approach. Then, a cross-sectional survey of similar providers across Canada was undertaken via REDCap (Research Electronic Data Capture), using an adapted version of the Provider Attitudes toward Cardiac Rehabilitation and Referral scale. RESULTS Saturation was achieved upon interviewing 7 providers. Four themes arose: knowledge about clinics and their characteristics, providers' clinical expertise, communication and relationship with their patients, and clinic referral process and care continuity. Seventy-three providers completed the survey. The major negative factors affecting referral were skepticism regarding clinic benefit (4.1 ± 0.9/5), a bad patient experience and believing they are better equipped to manage the patient (both 3.9). Cardiologists more strongly endorsed clarity of referral criteria, referral as normative and within-practice referral supports as supporting appropriate referral versus other professionals ( P s < .02), among other differences. One-third (n = 13) reported the pandemic impacted their referral practices (eg, limits to in-person care, patient concerns). CONCLUSION Although there are some legitimate barriers to appropriate clinic referral, greater provider education and support could facilitate optimal patient access.
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Moghaddam N, Lindsay MP, Hawkins NM, Anderson K, Ducharme A, Lee DS, McKelvie R, Poon S, Desmarais O, Desbiens M, Virani S. Access to Heart Failure Services in Canada: Findings of the Heart and Stroke National Heart Failure Resources and Services Inventory. Can J Cardiol 2023; 39:1469-1479. [PMID: 37422257 DOI: 10.1016/j.cjca.2023.06.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND The rising incidence of heart failure (HF) in Canada necessitates commensurate resources dedicated to its management. Several health system partners launched an HF Action Plan to understand the current state of HF care in Canada and address inequities in access and resources. METHODS A national Heart Failure Resources and Services Inventory (HF-RaSI) was conducted from 2020 to 2021 of all 629 acute care hospitals and 20 urgent care centres in Canada. The HF-RaSI consisted of 44 questions on available resources, service,s and processes across acute care hospitals and related ambulatory settings. RESULTS HF-RaSIs were completed by 501 acute care hospitals and urgent care centres, representing 94.7% of all HF hospitalisations across Canada. Only 12.2% of HF care was provided by hospitals with HF expertise and resources, and 50.9% of HF admissions were in centres with minimal outpatient or inpatient HF capabilities. Across all Canadian hospitals, 28.7% did not have access to B-type natriuretic peptide testing, and only 48.1% had access to on-site echocardiography. Designated HF medical directors were present at 21.6% of sites (108), and 16.2% sites (81) had dedicated inpatient interdisciplinary HF teams. Among all of the sites, 28.1% (141) were HF clinics, and of those, 40.4% (57) had average wait times from referral to first appointment of more than 2 weeks. CONCLUSIONS Significant gaps and geographic variation in delivery and access to HF services exist in Canada. This study highlights the need for provincial and national health systems changes and quality improvement initiatives to ensure equitable access to the appropriate evidence-based HF care.
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Affiliation(s)
- Nima Moghaddam
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kim Anderson
- Dalhousie, University QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Anique Ducharme
- Institut de Cardiologie, de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Robert McKelvie
- St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Stephanie Poon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sean Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Hassanein M, Tageldien A, Badran H, Samir H, Elshafey WE, Hassan M, Magdy M, Louis O, Abdel‐Hameed T, Abdelhamid M. Current status of outpatient heart failure management in Egypt and recommendations for the future. ESC Heart Fail 2023; 10:2788-2796. [PMID: 37559352 PMCID: PMC10567665 DOI: 10.1002/ehf2.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 05/27/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
Heart failure (HF) represents one of the greatest healthcare burdens worldwide, and Egypt is no exception. HF healthcare programmes in Egypt still require further optimization to enhance diagnosis and management of the disease. Development of specialized HF clinics (HFCs) and their incorporation in the healthcare system is expected to reduce HF hospitalization and mortality rates and improve quality of care in Egypt. We conducted a literature search on PubMed on the requirements and essential infrastructure of HFCs. Retrieved articles deemed relevant were discussed by a panel of 10 expert cardiologists from Egypt and a basic HFC model for the Egyptian settings was proposed. A multidisciplinary team managing the HFC should essentially be composed of specialized HF cardiologists and nurses, clinical pharmacists, registered nutritionists, physiotherapists, and psychologists. Other clinical specialists should be included according to patients' needs and size and structure of individual clinics. HFCs should receive patients referred from primary care settings, emergency care units, and physicians from different specialties. A basic HFC should have the following fundamental investigations available: resting electrocardiogram, basic transthoracic echocardiogram, and testing for N-terminal pro-B-type natriuretic peptide. Fundamental patients' functional assessments are assessing the New York Heart Association functional classification and quality of life and conducting the 6 min walking test. guideline-directed medical therapy should be implemented, and device therapy should be utilized when available. In the first visit, once HF is diagnosed and co-morbidities assessed, guideline-directed medical therapy should be started immediately. Comprehensive patient education sessions should be delivered by HF nurses or clinical pharmacists. The follow-up visit should be scheduled during the initial visit rather than over the phone, and time from the initial visit to the first follow-up visit should be determined based on the patient's health status and needs. Home and virtual visits are only recommended in limited and emergency situations. In this paper, we provide a practical and detailed review on the essential components of HFCs and propose a preliminary model of HFCs as part of a comprehensive HF programme model in Egypt. We believe that other low-to-middle income countries could also benefit from our proposed model.
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Rodrigues T, Agostinho JR, Santos R, Cunha N, Silvério António P, Couto Pereira S, Brito J, Valente Silva B, Silva P, Rigueira J, Pinto FJ, Brito D. The value of multiparametric prediction scores in heart failure varies with the type of follow-up after discharge: a comparative analysis. ESC Heart Fail 2023; 10:2550-2558. [PMID: 37309653 PMCID: PMC10375116 DOI: 10.1002/ehf2.13949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/27/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023] Open
Abstract
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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Affiliation(s)
- Tiago Rodrigues
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - João R. Agostinho
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Rafael Santos
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Nelson Cunha
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Pedro Silvério António
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Sara Couto Pereira
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Joana Brito
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Beatriz Valente Silva
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Pedro Silva
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Joana Rigueira
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Fausto J. Pinto
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - Dulce Brito
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
| | - for the RICA‐HFteam Investigators
- Cardiology Department, Santa Maria University Hospital, CHULN, Cardiovascular Centre (CCUL), Lisbon School of MedicineUniversidade de LisboaAvenida Professor Egas Moniz MBLisboa1649‐028Portugal
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Mamataz T, Fowokan A, Hajaj AM, Asghar A, Abrahamyan L, McDonald M, Harkness K, Grace SL. Factors Affecting Referral and Patient Access to Heart Function Clinics in Ontario: A Qualitative Study of Stakeholders. CJC Open 2023; 5:421-428. [PMID: 37397612 PMCID: PMC10314100 DOI: 10.1016/j.cjco.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023] Open
Abstract
Background Though heart failure patients benefit from multidisciplinary care in heart function clinics (HFCs), utilization is suboptimal and inequitable. This study investigated factors influencing referral and patient access to HFCs from multiple stakeholders' perspectives, namely policy-makers (PM), providers at HFCs and patients. Methods In this qualitative study, semi-structured interviews with a purposive sample of Ontario stakeholders were conducted between February-June 2020 and July-December 2022 (paused due to pandemic) via Teams. Interview transcripts were concurrently analyzed using systematic text condensation with Nvivo. Two authors coded individually, with disagreements discussed with senior author. Results Interviews with 7 HFCs (6 physicians, 1 nurse), 6 PM and 4 patients were completed before saturation; 5 themes emerged. First, with regard to health system organization, stakeholders reported gaps related to continuity of care, limited capacity and insufficient funding. Second, with regard to referral appropriateness and timeliness, sub-themes related to unclear referral criteria, varying clinic scope, and delays in triage, testing and time-to-visit. The third theme related to clinic characteristics, raised issues of varying clinic services and composition of healthcare professions/expertise. The fourth theme regarding patient factors related to comorbidity/frailty, socioeconomic status, barriers due to location (parking, traffic) and affinity to specific providers. The final theme related to the COVID-19 pandemic concerned increased referral volumes, loss to follow-up care, transition to online delivery modalities and patient refusal of in-person visits. Many facilitators to improve HFC referral and access were raised. Conclusions Resources must be provided, and stakeholders brought together to standardize and integrate the HF care continuum.
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Affiliation(s)
- Taslima Mamataz
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Adeleke Fowokan
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Areeba Asghar
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto General Research Institute, Toronto, Ontario, Canada
| | | | - Michael McDonald
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Karen Harkness
- Ontario Health–CorHealth Ontario, North York, Ontario, Canada
- McMaster University, School of Nursing, Hamilton, Ontario, Canada
| | - Sherry L. Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Fowokan A, Frankfurter C, Dobrow MJ, Abrahamyan L, Mcdonald M, Virani S, Harkness K, Lee DS, Pakosh M, Ross H, Grace SL. Referral and access to heart function clinics: A realist review. J Eval Clin Pract 2021; 27:949-964. [PMID: 33020996 DOI: 10.1111/jep.13489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 12/24/2022]
Abstract
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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Affiliation(s)
| | | | - Mark J Dobrow
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lusine Abrahamyan
- University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Sean Virani
- St. Paul's Hospital, University of British Columbia, and Cardiac Services BC, Vancouver, British Columbia, Canada
| | - Karen Harkness
- CorHealth Ontario, Toronto, Ontario, Canada.,School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Douglas S Lee
- University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto, Ontario, Canada
| | - Heather Ross
- University Health Network, Toronto, Ontario, Canada
| | - Sherry L Grace
- University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Faculty of Health, York University, Toronto, Ontario, Canada
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A 2020 Environmental Scan of Heart Failure Clinics in Ontario. CJC Open 2021; 3:929-935. [PMID: 34401700 PMCID: PMC8348555 DOI: 10.1016/j.cjco.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Multidisciplinary heart failure (HF) clinics decrease hospital admission rates and healthcare use, while improving patient outcomes. To understand the contemporary availability of HF clinics in Ontario, Canada, and the services provided, we performed an environmental scan of physician-led and nurse practitioner (NP)–led HF clinics. Methods Between November, 2019 and February 2020, we identified Ontario HF clinics led by physicians or NPs. Following an invitation, we conducted a semi-structured interview to evaluate the services offered and qualitatively compared our findings to the results of the 2010 Ontario provincial survey. Results The number of HF clinics (36 vs 34 in 2010) and physicians (157 vs 143 in 2010) have not changed since the 2010 survey. Of the 36 clinics we identified, 30 participated in our interview (22 physician-led and 8 NP-led). Twenty-five clinics (83%) were hospital-based, of which 9 (30%) were part of an academic institution. Comparisons of our findings to the 2010 study on 30 clinics show an approximately 3-fold increase (P <0.001) in both median annual and new patient visits. As previously reported, the clinics varied in services offered, but trended toward an increased availability of onsite echocardiography, exercise-stress testing, and nuclear cardiology. Conclusions Compared to the survey performed a decade ago, the number of HF clinics and physicians have not changed, and the services provided remain heterogenous. However, the increased number of patients served suggests a greater demand for these clinics. Improving the accessibility of these clinics and standardizing the service model are critical to improving patient outcomes.
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Tsukada YT, Kodani E, Asai K, Yasutake M, Seino Y, Shimizu W. Status of Medical Care and Management Requirements of Elderly Patients With Heart Failure in a Comprehensive Community Health System - Survey of General Practitioners' Views. Circ Rep 2021; 3:77-85. [PMID: 33693293 PMCID: PMC7939955 DOI: 10.1253/circrep.cr-20-0132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background:
Given the high prevalence of heart failure (HF) in the elderly, it is essential to establish medical coordination between general practitioners (GPs) and acute care hospitals (ACHs) in an aging society. The aim of this study was to elucidate the status of acceptance of elderly patients with HF and their management requirements in a comprehensive community health system. Furthermore, we investigated GPs’ interest in using information and communications technology (ICT) in patient care. Methods and Results:
We sent a questionnaire survey to 1,800 GPs in January 2015 and received 392 replies. The overall prevalence of home visits was 55%, with no differences according to GP background characteristics or geographic area. However, less than half (44%) reported accepting patients with symptomatic HF for treatment in their clinic. In addition, only 3 GPs reported accepting and providing emergency visits for patients with refractory HF. In particular, GPs who were not certificated cardiologists, female, and older showed poorer acceptance of symptomatic HF patients. More than half the GPs wanted the prompt acceptance by ACHs of emergency patients, followed by strengthening of home care support at discharge and support for end-of-life care. Half the GPs were interested in telemedicine. Conclusions:
ACHs must promptly accept patients with HF in cases of emergency and strengthen nursing care support at discharge. It is also necessary to consider how to support older and female GPs.
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Affiliation(s)
- Yayoi Tetsuou Tsukada
- Department of General Medicine and Health Science, Nippon Medical School Tokyo Japan.,Department of General Medicine, Nippon Medical School Musashi Kosugi Hospital Kawasaki Japan
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Kuniya Asai
- Department of Cardiovascular Care Unit, Nippon Medical School Chiba Hokusoh Hospital Inzai Japan
| | - Masahiro Yasutake
- Department of General Medicine and Health Science, Nippon Medical School Tokyo Japan
| | - Yoshihiko Seino
- Department of Cardiovascular Medicine, Nippon Medical School Tokyo Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Tokyo Japan
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Virani SA, Clarke B, Ducharme A, Ezekowitz JA, Heckman GA, McDonald M, Mielniczuk LM, Swiggum E, Van Spall HGC, Zieroth S. Optimizing Access to Heart Failure Care in Canada During the COVID-19 Pandemic. Can J Cardiol 2020; 36:1148-1151. [PMID: 32405146 PMCID: PMC7217768 DOI: 10.1016/j.cjca.2020.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 01/07/2023] Open
Abstract
The traditional model of heart failure (HF) care in Canada, which relies upon a multidisciplinary team and clinic-based care processes, has been undermined as a result of the COVID-19 pandemic. As the pandemic continues, we will be challenged to improve or maintain the health status of those with HF by optimizing guideline-directed care despite physical distancing constraints and a reduction in the health care workforce. This will require development of new strategies specifically targeted at decreasing the risk of decompensation and resultant HF hospitalization. As such, we must quickly pivot to the adoption and application of novel technologies and revise usual care models, processes, and workflow. The unprecedented COVID-19 crisis has delivered the Canadian HF community a burning platform for the design and implementation of innovative approaches to support the vulnerable population we serve; born out of necessity, we now have the opportunity to explore innovative approaches that might inform the future of HF care delivery in Canada. Herein, we provide perspectives from leadership within the Canadian Heart Failure Society on how to optimize HF care during the COVID-19 pandemic.
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Affiliation(s)
- Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada.
| | - Brian Clarke
- Libin Cardiovascular Institute and the University of Calgary, Calgary, Alberta, Canada
| | - Anique Ducharme
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre and the University of Alberta, Edmonton, Alberta, Canada
| | | | - Michael McDonald
- Peter Munk Cardiac Centre and the University of Toronto, Toronto, Ontario, Canada
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