Ambulatory Care Services for Patients with Chronic Heart Failure in Newfoundland and Labrador

Kean , Robert and Bornstein, Stephen and O'Brien, Stephanie (2013) Ambulatory Care Services for Patients with Chronic Heart Failure in Newfoundland and Labrador. Project Report. Newfoundland and Labrador Centre for Applied Health Research, St. John's, Newfoundland, Canada.

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Abstract

Heart failure is a condition in which the heart is unable to pump out enough blood to meet the metabolic needs of the body. It can be caused by structural defects, functional abnormalities, or a sudden overload beyond its capacity. Chronic heart failure (CHF) is more common than acute heart failure, which results from sudden insult to cardiac function. CHF is diagnosed in 1–2% of the general population in industrialized countries, and spending on the disease represents 1–2% of their total health-care expenditures. Mortality and hospitalization rates associated with CHF are among the highest of any medical condition. On the suggestion of the Central Regional Health Authority,1 our stakeholder partners have asked us to identify any and all ambulatory care programs and interventions that have been shown to reduce hospital admissions and mortality among patients with CHF. In requesting this review, our partners have noted that: There is a significant demand for acute care beds… At times, surgeries have to be cancelled and patients are on stretchers in the ER for significant periods of time. Patients with chronic conditions are sometimes admitted to hospital as the required outpatient programs/services have not been developed to provide the required level of care for these patients. This review defines “ambulatory care” as any sort of service or program provided outside an acute hospital inpatient unit. This includes professional services delivered in outpatient clinics, in patients’ homes, or via some form of telehealth technology. At the stakeholders’ request, we have not included research articles that focus exclusively on models of patient self-management; however, some of the articles reviewed here evaluate packages of interventions that include a self-management component. We have also excluded from the analysis articles that focus exclusively on either prescription medications or surgical interventions. Our review is further limited to research articles that measure the effect of programs on both hospitalization and mortality rates. Our research question is as follows: “What ambulatory care services and/or programs have proved effective in reducing hospitalization and mortality among patients with chronic heart failure?”

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