York University, Faculty of Health, Toronto, Ontario, Canada.
Can J Cardiol. 2012 Jul-Aug;28(4):483-9. doi: 10.1016/j.cjca.2011.11.020. Epub 2012 Feb 25.
Heart failure (HF) clinics have been shown to reduce hospital readmissions and generally have favourable effects on quality of life, survival, and care costs. This study investigated the rates of referral and use of HF clinics and examined factors related to program use.
This study represents a secondary analysis of a larger prospective cohort study conducted in Ontario. In hospital, 474 HF inpatients from 11 hospitals across Ontario completed a survey that examined predisposing, enabling, and need factors affecting HF clinic use. Then 1 year later, 271 HF patients completed a mailed survey that assessed referral to and use of HF clinics.
Forty-one patients (15.2%) self-reported referral, and 35 (13%) self-reported attending an HF clinic. Generalized estimating equations showed that factors related to greater program use were having an HF clinic at the site of hospital recruitment (odds ratio [OR] = 8.40; P = 0.04), referral to other disease management programs (OR = 4.87; P = 0.04), higher education (OR = 4.61; P = 0.02), lower stress (OR = 0.93; P = 0.03), and lower functional status (OR = 0.97; P = 0.03).
Similar to previous research, only one-seventh of HF patients were referred to and used an HF clinic. Both patient-level and health-system factors were related to HF clinic use. Given the benefits of HF clinics, more research examining how equitable access can be increased is needed. Also, the appropriateness and cost repercussions of use of multiple disease management programs should be investigated.
心衰（HF）诊所已被证明可降低住院再入院率，并且通常对生活质量、生存率和医疗费用有有利影响。本研究调查了 HF 诊所的转诊和使用率，并探讨了与项目使用相关的因素。
本研究代表在安大略省进行的一项更大的前瞻性队列研究的二次分析。在医院，来自安大略省 11 家医院的 474 名 HF 住院患者完成了一项调查，该调查检查了影响 HF 诊所使用的倾向、促成和需求因素。然后，1 年后，271 名 HF 患者完成了一项邮寄调查，评估了 HF 诊所的转诊和使用情况。
41 名患者（15.2%）自述转诊，35 名患者（13%）自述就诊 HF 诊所。广义估计方程显示，与更大程度使用该计划相关的因素包括医院招募地点有 HF 诊所（优势比[OR] = 8.40；P = 0.04）、转诊至其他疾病管理计划（OR = 4.87；P = 0.04）、较高的教育程度（OR = 4.61；P = 0.02）、较低的压力（OR = 0.93；P = 0.03）和较低的功能状态（OR = 0.97；P = 0.03）。
与先前的研究类似，只有七分之一的 HF 患者被转诊并使用 HF 诊所。患者水平和卫生系统因素均与 HF 诊所的使用有关。鉴于 HF 诊所的益处，需要更多研究来探讨如何增加公平获得机会。此外，还应研究使用多种疾病管理计划的适当性和成本影响。
