Document Detail


Heart failure clinics are associated with clinical benefit in both tertiary and community care settings: data from the Improving Cardiovascular Outcomes in Nova Scotia (ICONS) registry.
MedLine Citation:
PMID:  19746249     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Heart failure (HF) clinics are known to improve outcomes of patients with HF. Studies have been limited to single, usually tertiary centres whose experience may not apply to the general HF population.
OBJECTIVES: To determine the effectiveness of HF clinics in reducing death or all-cause rehospitalization in a real-world population.
METHODS: A retrospective analysis of the Improving Cardiovascular Outcomes in Nova Scotia (ICONS) disease registry was performed. All 8731 patients with a diagnosis of HF (844 managed in HF clinics) who were discharged from the hospital between October 15, 1997, and July 1, 2000, were identified. Patients enrolled in any one of four HF clinics (two community-based and two academic-based) were compared with those who were not. The primary outcome was the one-year combined hospitalization and mortality.
RESULTS: Patients followed in HF clinics were younger (68 versus 75 years), more likely to be men (63% versus 48%), and had a lower ejection fraction (35% versus 44%), lower systolic blood pressure (137 mmHg verus 146 mmHg) and lower serum creatinine (121 micromol/L versus 130 micromol/L). There was no difference in the prevalence of hypertension (56%), diabetes (35%) or stroke/transient ischemic attack (16%). The one-year mortality rate was 23%, while 31% of patients were rehospitalized; the combined end point was 51%. Enrollment in an HF clinic was independently associated with reduced risk of total mortality (hazard ratio [HR] 0.69 [95% CI 0.51 to 0.90], P=0.008; number needed to treat for one year to prevent the occurrence of one event [NNT]=16), all-cause hospital readmission (HR 0.27 [95% CI 0.21 to 0.36], P<0.0001; NNT=4), and combined mortality or hospital readmission (HR 0.73 [95% CI 0.60 to 0.89], P<0.0015; NNT=5).
DISCUSSION: HF clinics are associated with reductions in rehospitalization and mortality in an unselected HF population, independent of whether they are academic- or community-based. Such clinics should be made widely available to the HF population.
Authors:
Jonathan G Howlett; O Elizabeth Mann; Robert Baillie; Ronald Hatheway; Anna Svendsen; Rosalind Benoit; Carol Ferguson; Marlene Wheatley; David E Johnstone; Jafna L Cox
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  25     ISSN:  1916-7075     ISO Abbreviation:  Can J Cardiol     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-11     Completed Date:  2009-09-29     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  e306-11     Citation Subset:  IM    
Affiliation:
Heart Foundation Clinic, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia B3H 3A7, Canada. jonathan.howlett@cdha.nshealth.ca
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MeSH Terms
Descriptor/Qualifier:
Aged
Community Health Centers / organization & administration*
Female
Follow-Up Studies
Heart Failure / epidemiology,  therapy*
Hospitals, Special / organization & administration*
Humans
Length of Stay / statistics & numerical data*
Male
Morbidity / trends
Nova Scotia / epidemiology
Patient Admission / statistics & numerical data*
Prospective Studies
Quality Assurance, Health Care / trends*
Registries*
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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