Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada.
Can J Cardiol. 2013 Sep;29(9):1062-8. doi: 10.1016/j.cjca.2013.01.017. Epub 2013 Apr 24.
Heart failure (HF) clinics are associated with improved outcomes in randomized trials, however, there is substantial heterogeneity in the service models of HF clinics in practice. Our objective was to evaluate the effect of this clinic level heterogeneity on HF patient management in Ontario, Canada.
Charts were abstracted from 9 HF clinics, chosen at random from the 34 HF clinics in operation in Ontario in 2011. From each clinic, approximately 100 patient charts were randomly selected for detailed abstraction on patient demographic characteristics, comorbidities, diagnostic tests, medication use, and referrals, over a 1-year period from the first clinic visit.
Significant heterogeneity was observed in patient baseline profiles, pharmacological therapies, diagnostic testing, clinic personnel, and referrals across 9 clinics. The mean age of patients was 66.1 ± 15.7 years and was significantly different between the clinics. Most patients were male (65%), and mean left ventricular ejection fraction was 33%. There was significant variation in the utilization of echocardiography (42%-94%) and coronary angiography (19%-62%). Overall, approximately 88% of patients were prescribed angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers, and 85% were prescribe β-blockers. The rates of referral to cardiac rehabilitation programs were overall low at 10.4% of patients, with substantial variation (1%-28%).
Specialized HF clinics have wide variation in the health personnel involved and the care provided; in addition, patients treated at these HF clinics have important differences in clinical characteristics. Strategies should be considered at the appropriate level (eg, province-wide in Ontario) to standardize HF management and provide best evidence-based care to patients.
心力衰竭（HF）诊所与随机试验中改善的结果相关，然而，HF 诊所的服务模式在实践中存在显著的异质性。我们的目的是评估这种诊所水平的异质性对加拿大安大略省 HF 患者管理的影响。
从 2011 年安大略省运营的 34 个 HF 诊所中随机选择 9 个诊所，从每个诊所中随机抽取大约 100 份患者病历，详细摘录患者人口统计学特征、合并症、诊断测试、药物使用和转诊情况，为期 1 年，从第一次就诊开始。
在 9 个诊所中，观察到患者基线特征、药物治疗、诊断测试、诊所人员和转诊方面存在显著的异质性。患者的平均年龄为 66.1±15.7 岁，且在各诊所之间存在显著差异。大多数患者为男性（65%），平均左心室射血分数为 33%。超声心动图（42%-94%）和冠状动脉造影（19%-62%）的使用存在显著差异。总体而言，约 88%的患者被处方血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂，85%的患者被处方β受体阻滞剂。心脏康复计划的转诊率总体较低，为 10.4%的患者，差异较大（1%-28%）。
专门的 HF 诊所涉及的卫生人员和提供的护理存在广泛的差异；此外，在这些 HF 诊所接受治疗的患者在临床特征方面存在重要差异。应在适当的层面（例如安大略省全省）考虑采用策略，以标准化 HF 管理并为患者提供最佳循证护理。
