Philadelphia, 11 December 2008 Heart failure (HF) clinics are an increasingly important approach to the treatment of patients with heart failure, yet there have been no published standards regarding the care provided by these specialized clinics. To address this gap, the Quality of Care Committee of the Heart Failure Society of America (HFSA) has developed a consensus statement summarizing the rationale, goals, and components of HF clinic care. The statement appears in the December issue of the Journal of Cardiac Failure (http://www.onlinejcf.com/), published by Elsevier.
Based on analysis of the best available research by an expert panel, the statement helps to define the structure and process of care provided by HF clinics. "The goals of the HF clinic are to reduce mortality and rehospitalization rates and improve quality of life for HF patients through individualized patient care," write the Committee members, led by Paul J. Hauptman, M.D., of Saint Louis University School of Medicine.
The statement defines "a family of 11 domains of care" provided by HF clinics, outlining specific components of care in each domain. For example, in the domain of Disease Management, the statement highlights the HF clinic's role in providing comprehensive education and counseling for patients and their families or caregivers, with the aim of promoting self-care.
Disease management also encompasses efforts to ensure that patients receive optimal medical therapy, appropriate follow-up, and assistance with social and financial concerns. A provider-to-patient ratio enabling individualized care and an infrastructure that allows for integration and coordination of care are also essential components of the HF clinic approach.
Other domains include Functional Status Assessment and Quality of Life Assessment. In these areas, the statement outlines essential tests and tools used to evaluate patients' health and functioning. In the Medical Therapy and Drug Evaluation domain, the goal is to ensure that treatment is consistent with current evidence-based guidelines, including systems for reviewing medications and for identifying patients who are not receiving optimal therapy. A similar process applies to Device Evaluation, reflecting the growing use of medical devices in patients with heart failure.
The statement also includes detailed information on the domains of Nutritional Assessment, Follow-Up, Advance Planning, Communication, Provider Education, and Quality Assessment in HF clinic care. "The 'HF clinic' has become a vital element in comprehensive care of the patient with HF," Dr. Hauptman and colleagues write. The Committee hopes the new statement will promote an appreciation of the essential features of the HF clinic approach, and its potential to improve patient outcomes.
"The management of heart failure has become both more complex and more successful," comments Barry M. Massie, M.D., Editor-in-Chief of Journal of Cardiac Failure. "Multidisciplinary clinics and programs can play an important role, both at the onset of this condition and in its more advanced stages. This document provides an outstanding overview of the rationale and goals of the heart failure clinic, as well as very practical guidance on how to organize and implement such a program."
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