Referral and use of heart failure clinics: What factors are related to utilization?

Background: Due to its growing prevalence, heart failure (HF) has become a major burden worldwide. HF clinics have been shown to reduce hospital readmissions, and generally have favorable effects on quality of life, survival and care costs. This study investigated the rates of referral and utilization of HF clinics, and examined factors related to program use. Methods: 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. Clinical and demographic data were extracted from medical charts. One-year later, 271 HF patients completed a mailed survey that assessed referral to and use of HF clinics. Data were collected between the years 2006-2008 and analyses ensued in 2010. Results: Forty-one patients(15.1%) self-reported referral, and 35(12.9%) reported attending a HF clinic (85% of those referred) at 1 of 16 sites. Generalized estimating equations showed that factors related to greater program use were: having a 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). Conclusion: Similar to previous research, only one-seventh of HF patients were referred and used a 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.