Outpatient heart failure (HF) clinics that provide patient education on ways to manage heart failure and risk factors, prescribe home-based exercises, and monitor therapy compliance have been shown to reduce morbidity, mortality, and health care costs.
A new study published in the current issue of the Canadian Journal of Cardiology finds that despite guidelines that encourage physicians to recommend heart failure clinics, very few patients recently hospitalized with HF receive referrals or use one.
"Given the demonstrated benefits of these services, the rates of referral and enrollment in our study are discouragingly low," says lead investigator Shannon Gravely, PhD, York University, University Health Network, and Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
The investigators recruited 474 HF inpatients from 11 hospitals across Ontario. The patients completed a survey that evaluated environmental and individual factors affecting HF clinic use. Environmental factors included hospital type, whether the hospital had an onsite HF clinic, and whether the patient had been referred to other outpatient disease management programs (DMP), such as smoking cessation clinics or diabetes education. Individual factors included sociodemographic information, whether the patient lived in a rural area, marital status, perceived stress, and depressive symptoms.
Clinical indicators of the need for rehabilitative services were gathered from patient charts. A year after the first survey, the patients received a second survey and reported whether they had been referred to an HF clinic, and if they had attended. 270 patients completed the follow-up survey and were included in the analysis.
Results showed that 15% of study participants were referred to, and 13% reported using an HF clinic. Patients with higher education were five times more likely to use an outpatient HF clinic compared to those with lower education. Lower stress levels and more serious health conditions were also associated with HF use. Patients who received a referral to another DMP were nearly five times more likely to use an HF clinic.
The most important factor in determining whether a patient used an HF clinic was the presence of an established program at the patient's original hospital. "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," says Dr. Gravely.
In a related study published in the same issue, Dr. Gravely and colleagues examined more broadly the use of DMPs by patients with cardiovascular disease (CVD). 1,803 hospitalized patients completed a survey about factors that influenced DMP use and a follow-up study a year later that assessed whether they had used any DMPs: cardiac rehabilitation, outpatient diabetes education, an HF clinic, stroke rehabilitation, or a smoking cessation program.
Overall, roughly 40% of patients did not access any post-acute DMPs. Fifty percent accessed one program, and 10% attended more than one. Among participants with a comorbid indication (diabetes, stroke, heart failure, or smokers), 21% of these participants reported that they used multiple programs. DMP participants were younger, more likely to be married, and more highly educated than those who did not attend DMPs. Overall, 53% reported participating in cardiac rehabilitation, and among participants with a comorbid illness or risk, 41% of diabetics reported attending a diabetes education center, 26% of stroke patients attended stroke rehabilitation, 13% of patients with a heart failure diagnosis used a heart failure clinic, and 12% of smokers attended a smoking cessation program. Among all study participants these findings suggest a gross underuse of DMP services, particularly stroke rehabilitation, HF clinics, and most notably, smoking cessation programs.
"What is one of the most concerning findings is that only 12% of current smokers reported taking part in a smoking cessation program," notes Dr. Gravely. "Participation in smoking cessation programs results in significantly higher cessation rates when compared with standard care."
Dr. Gravely notes that future research is needed to explore not only patient-related factors, but also health-system factors such as awareness and capacity that may be at play. "The appropriateness and cost repercussions of multiple DMP use should be investigated, as an integrated approach to vascular disease management may be warranted," she concludes.Notes for Editors
"A Prospective Examination of Disease Management Program Use by Complex Cardiac Outpatients," by Shannon Gravely, PhD, Robert D. Reid, PhD, MBA, Paul Oh, MD, FRCPC, Heather Ross, MD, FRCPC, Donna E. Stewart, MD, FRCPC, Sherry L. Grace, PhD on behalf of the Cardiac Rehabilitation Care Continuity Through Automatic Referral Evaluation (CRCARE) Investigators (DOI 10.1016/j.cjca.2012.01.004)
They appear in Canadian Journal of Cardiology, Volume 28, Issue 4 (July/August 2012), published by Elsevier.About the Canadian Journal of Cardiology
Elsevier is a world-leading provider of scientific, technical and medical information products and services. The company works in partnership with the global science and health communities to publish more than 2,000 journals, including The Lancet and Cell, and close to 20,000 book titles, including major reference works from Mosby and Saunders. Elsevier's online solutions include ScienceDirect, Scopus, Reaxys, MD Consult and Nursing Consult, which enhance the productivity of science and health professionals, and the SciVal suite and MEDai's Pinpoint Review, which help research and health care institutions deliver better outcomes more cost-effectively.
A global business headquartered in Amsterdam, Elsevier employs 7,000 people worldwide. The company is part of Reed Elsevier Group PLC, a world-leading publisher and information provider, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange).Media contact
Erika Brown-Schumann | EurekAlert!
Further reports about: > Automatic > Canadian Light Source > Cardiac Medicine > Cardiology > DMP > Despite > Electrophysiology > FRCPC > Heart Failure Clinics > Ontario > cardiac rehabilitation > cardiovascular disease > disease management > health care > health condition > heart failure > risk factor > smoking cessation programs > vascular disease
New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)
Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology
More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.
Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...
Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.
"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...
The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.
Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...
The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...
Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.
Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...
20.04.2017 | Event News
18.04.2017 | Event News
03.04.2017 | Event News
24.04.2017 | Physics and Astronomy
24.04.2017 | Materials Sciences
24.04.2017 | Life Sciences