Open Access Research article

Specialized multi-disciplinary heart failure clinics in Ontario, Canada: an environmental scan

Harindra C Wijeysundera123*, Gina Trubiani2, Lusine Abrahamyan2, Nicholas Mitsakakis2, William Witteman2, Mike Paulden2, Gabrielle van der Velde24, Kori Kingsbury5 and Murray Krahn2367

Author Affiliations

1 Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Ontario, Canada

2 Toronto Health Economics and Technology Assessment (THETA) Collaborative, Ontario, Canada

3 Department of Medicine, University of Toronto, Ontario, Canada

4 Institute for Work & Health, Ontario, Canada

5 Cardiac Care Network of Ontario, Ontario, Canada

6 University Health Network – Toronto General Hospital, Ontario, Canada

7 Faculty of Pharmacy, University of Toronto, Ontario, Canada

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BMC Health Services Research 2012, 12:236  doi:10.1186/1472-6963-12-236

Published: 3 August 2012



Multi-disciplinary heart failure (HF) clinics have been shown to improve outcomes for HF patients in randomized clinical trials. However, it is unclear how widely available specialized HF clinics are in Ontario. Also, the service models of current clinics have not been described. It is therefore uncertain whether the efficacy of HF clinics in trials is generalizable to the HF clinics currently operating in the province.


As part of a comprehensive evaluation of HF clinics in Ontario, we performed an environmental scan to identify all HF clinics operating in 2010. A semi-structured interview was conducted to understand the scope of practice. The intensity and complexity of care offered were quantified through the use of a validated instrument, and clinics were categorized as high, medium or low intensity clinics.


We identified 34 clinics with 143 HF physicians. We found substantial regional disparity in access to care across the province. The majority of HF physicians were cardiologists (81%), with 81% of the clinics physically based in hospitals, of which 26% were academic centers. There was a substantial range in the complexity of services offered, most notably in the intensity of education and medication management services offered. All the clinics focused on ambulatory care, with only one having an in-patient focus. None of the HF clinics had a home-based component to care.


Multiple HF clinics are currently operating in Ontario with a wide spectrum of care models. Further work is necessary to understand which components lead to improved patient outcomes.