Heart failure clinics and outpatient management: review of the evidence and call for quality assurance

Despite major advances in treatment options for heart failure patients, morbidity and mortality remain unacceptably high. Frequent readmissions are distressful for patients and are associated with large costs for society. In an attempt to improve care for heart failure patients and thereby reduce morbidity and hospital readmissions, specialised heart failure clinics have emerged over the last 10 years. In particular, clinics relying, at least in part, on nurses specially trained in heart failure have gained popularity. This review of the published literature describes the wide variety of designs and the types of interventions taking place in such heart failure clinics. A total of 18 randomised studies comparing heart failure clinics using nurse intervention with conventional care have been published to date, and the majority of these have shown either a reduction in hospital readmissions or shortening of hospitalisations in the intervention group. These findings are supported by the results of several non-randomised, controlled investigations. Thus, it is concluded that heart failure clinics using nurse intervention should be an integrated part of the care process for patients with heart failure wherever possible. We argue that ongoing attention should be paid to the quality of care delivered by the clinics to ensure that the benefit of this intervention strategy persists. Thus, it would be of importance to continuously record relevant data describing the care process using specific indicators such as ACE-inhibitor and beta-blocker use and doses. One possible, practical method to apply such continuous quality assurance may be by means of electronic medical record databases.