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HF clinics rarely used despite clear benefits
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Outpatient HF clinics have been shown to reduce morbidity, mortality and health care costs, but only one-seventh of patients who participated in a recent study were referred to and used an HF clinic.
Researchers recruited 474 HF patients from 11 hospitals in Ontario, Canada. Patients completed a survey that evaluated environmental and individual factors affecting HF clinic use. One year later, patients received a second survey and reported whether they had been referred to a HF clinic and if they had attended.
Fifteen percent of the 270 patients who completed the follow-up survey reported referral to a HF clinic, and 13% reported using a HF clinic.
“Given the demonstrated benefits of these services, the rates of referral and enrollment in our study are discouragingly low,” Shannon Gravely, PhD, of York University, University Health Network, and Toronto Rehabilitation Institute, Toronto, said in a press release.
Patients with a higher education level were five times more likely to use an outpatient HF clinic compared with those with a lower education level (OR=4.61; P=.02). Patients who received referral to another disease management program were nearly five times more likely to use a HF clinic (OR=4.87; P=.04). Lower stress levels (OR=0.93; P=.03) and lower functional status (OR=0.97; P=.03) were also associated with greater clinic use.
The most important factor in determining whether a patient used a HF clinic was the presence of an established program at the patient’s original hospital (OR=8.4; P=.04).
“It’s likely that having an HF clinic on site is related to greater awareness of the benefits of such services by physicians providing care. However, broader referral mechanisms are needed to ensure that all patients, regardless of where they receive care, have equitable access to HF clinics,” Gravely stated in the release.
Calculated use of disease management programs
In a related study also published in the Canadian Journal of Cardiology, Gravely and colleagues examined the use of disease management programs by patients with CVD. The study included 1,803 hospitalized patients who completed surveys at baseline and 1 year about factors that influenced disease management program use and use of these services.
Forty percent of patients did not attend any postacute disease management programs; 50% attended one program; and 10% attended more than one. Among patients with a comorbid condition, 21% reported using multiple programs.
Analyzed by type, 53% of patients reported participating in cardiac rehabilitation. Among patients with a comorbid condition or stroke, 41% of diabetes patients reported attending a diabetes education center; 26% of stroke patients reported attending stroke rehabilitation; 13% of HF patients reported attending a HF clinic; and 12% of smokers reported attending a smoking cessation program.
Among all participants, these results suggest a gross underuse of disease management program services, particularly stroke rehabilitation, HF clinics and smoking cessation programs, the researchers concluded.
Patients who used these services were younger, more likely to be married, had a history of MI, were less likely to have had a PCI, and had a higher education level vs. patients who did not.
Efforts to increase access
The researchers concluded: “Given the benefits of HF clinics, more research examining how equitable access can be increased is needed.”
In addition, they suggested continued investigation of the appropriateness and cost repercussions of the use of multiple disease management programs.
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Disclosure: The researchers report no relevant financial disclosures.