Point/Counterpoint
Heart Failure Clinics Are Still Useful (More Than Ever?)

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Abstract

Heart failure (HF) clinics have had an important role in optimal HF management and the effectiveness of these clinics has been studied intensively. A HF clinic is one of the various ways to organize a HF disease management program. There is good evidence that HF disease management can improve outcomes in HF patients, but it is not clear what the optimal components of these programs are and what the relative effectiveness of a HF clinic is compared with other forms of HF management. After initial positive reports on the effect of HF clinics, these clinics were implemented in many countries, although in different formats and of varying quality. In this article we describe the initial need for HF clinics, reflect on their development over time, and discuss the role of HF clinics in context of the current need for HF disease management.

Résumé

Les cliniques d’insuffisance cardiaque (IC) ont joué un rôle important dans la prise en charge optimale de l’IC, et l’efficacité de ces cliniques a été étudiée de manière approfondie. Une clinique d’IC est l’une des diverses façons d’organiser un programme de prise en charge de l’IC. Des données fiables attestent que la prise en charge de l’IC peut améliorer les résultats chez les patients ayant une IC, mais on ne sait pas clairement ce que sont les composantes optimales de ces programmes et ce qu’est l’efficacité relative d’une clinique d’IC comparativement à d’autres formes de prise en charge de l’IC. Après les rapports initiaux positifs sur l’effet des cliniques d’IC, ces cliniques ont été mises en place dans plusieurs pays, quoiqu’elles soient de formes diverses et de qualité variable. Dans cet article, nous décrivons les besoins initiaux concernant les cliniques d’IC, réfléchissons à leur développement futur et discutons de leur rôle dans le contexte des besoins actuels de prise en charge de l’IC.

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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