Point/CounterpointHeart Failure Clinics Are Still Useful (More Than Ever?)
Section snippets
Phase 1: First Need and Development
The first HF disease management programs were established in the 1990s as a solution to the high readmission rate of patients and their poor prognosis. Readmissions were often seen as preventable and were related to nonadherence, inadequate medical treatment, or inadequate reaction of patients and health care providers to deterioration. HF clinics in the first landmark studies included several components such as patient education, optimization of medication, and close follow-up, either in
Phase 2: Implementation and Reflection
After the first successful trials and positive meta-analysis, major guidelines recommended HF management programs for recently hospitalized HF patients and for other high-risk patients.1, 2 Because delivery of care varies in different health care systems worldwide, the organization of a HF management program was advised to be based on patient needs, financial resources, available personnel, and administrative policies, and adapted to local priorities and infrastructure,13 implying that it is
Phase 3: Current State and Future Challenges
Several challenges remain in optimal care delivery and the HF management programs need to consider issues related to the place of delivery, quality, and new patient groups. In addition, HF clinics need to be adaptive for patients over time because they will need more or less of the components in a HF clinic during their HF trajectory.
Final Reflection: Heart Failure Clinics Are STILL Useful (More Than Ever?)
In general, management of HF patients is far from optimal at this moment. Although clear guidelines on diagnosis and treatment are available, patients are not always diagnosed in time and not all patients receive optimal medical treatment or nonpharmacological advice. Major gains can still be made, especially with regard to symptom monitoring and increasing exercise. In addition, structured follow-up is needed along the disease trajectory and early intervention in case of deterioration is vital
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (21)
Cost-effectiveness of home versus clinic-based management of chronic heart failure: Extended follow-up of a pragmatic, multicentre randomized trial cohort - The WHICH? study (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care)
2015, International Journal of CardiologyCitation Excerpt :Home-visiting programs and multidisciplinary HF-clinic interventions have been shown to reduce all-cause readmissions and mortality [23], supporting the need to directly compare the commonly-used programs: CBI versus HBI. Ultimately, what matters may be the quality, structure, component and availability of the follow-up rather than the location of follow-up [50] per se. If, however, the place of delivery such as home serves as a proxy of highly individualized care or a catalyst for changes needed to establish routines and patient's automaticity [51], the location or setting in which care is delivered could well be a key determinant of benefit.
Referral and access to heart function clinics: A realist review
2021, Journal of Evaluation in Clinical PracticeInterdepartmental program to improve outcomes for acute heart failure patients seen in the emergency department
2021, Canadian Journal of Emergency MedicineLong term outcome of heart failure patients disqualified from heart transplantation
2021, Acta Cardiologica
See article by Howlett, pages 276-280 of this issue.
See page 274 for disclosure information.