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Canadian Journal of Cardiology

Specialist Heart Failure Clinics Must Evolve to Stay Relevant

  • Jonathan G. Howlett
    Correspondence
    Corresponding author: Dr Jonathan G. Howlett, Department of Medicine, University of Calgary and Libin Cardiovascular Institute, Room C838, 1403-29th Street NW, Calgary, Alberta T2N 2Y9, Canada. Tel.: +1-403-944-232; fax: +1-403-944-3262.
    Affiliations
    Department of Cardiac Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, Alberta, Canada
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Published:January 02, 2014DOI:https://doi.org/10.1016/j.cjca.2013.12.022

      Abstract

      The widespread acceptance of heart-failure (HF) clinics is based on studies with poor and poorly-described care. This led to HF-clinic proliferation, often with access for a small percentage of younger, healthier and generally affluent patients. This system fails to provide the essential timely access to specialist-team consultation following hospital-discharge. Recent well-conducted randomized trials of HF-clinic care found no benefit over usual care. To provide optimal value, HF-clinics must evolve to devote resources to timely assessment/reassessment and close follow-up of selected high-risk/advanced HF patients, along with timely support of the primary-care team that will assure the bulk of routine HF care.

      Résumé

      L’acceptation généralisée des cliniques d’insuffisance cardiaque (IC) repose sur des études montrant des soins médiocres ou décrits comme étant médiocres. Cela a mené à la prolifération des cliniques d’IC, souvent accessibles à un pourcentage restreint de patients plus jeunes, en meilleure santé et habituellement mieux nantis. Ce système n’a pas offert l’accès en temps opportun à la consultation essentielle de l’équipe de spécialistes à la suite du congé de l’hôpital. Les récents essais aléatoires menés avec rigueur sur les soins offerts par les cliniques d’IC n’ont montré aucun avantage par rapport aux soins habituels. Pour offrir une valeur optimale, les cliniques d’IC devront consacrer leurs ressources à l’évaluation et à la réévaluation en temps opportun et offrir un suivi étroit aux patients ayant une IC avancée et étant exposés à un risque élevé, parallèlement à un soutien plus opportun de l’équipe de soins primaires qui assurera la majeure partie des soins courants aux patients atteints d’IC.
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