Feature: Heart Function Clinic

General DOM News & Events

| 1 February 2024

The Heart Function Clinic at KHSC was established in 2000 to provide evidence-based heart failure (HF) care to patients referred from the community, from KHSC hospitals and emergency departments (EDs), and from internists and cardiologists within and outside KHSC. The clinic follows nearly 40% of HF patients discharged from the hospital, which reduces the rates of readmission and return to the emergency department. This was demonstrated as early as 2002 in the 2 years after the clinic was launched, where rates of HF readmissions declined by 80% and ED visits by 83%.

With the rising age of our local population, the demand for HF care continued to grow. In response, the Heart Function Clinic expanded its staff and specialists. In June of 2000 when the clinic opened, it was run by 1 nurse practitioner (NP) supported by 1 cardiologist; now we have 4 NPs (2 part-time) working with 2 cardiologists.

Each team member brings a unique background/perspective. Wendy Earle (Cardiac Surgery/Medicine) is a staff nurse, educator, manager. Dianne Kirkpatrick is an educator, primary care nurse practitioner, with specialty in HF and care of the elderly and palliative care. Kelly McNabb has a surgical and critical care background as well as clinical research, and Sam Gouett has a background in Internal Medicine, in-patient care, and has developing interests in point-of-care ultrasound.

Given the high prevalence of arrhythmias in HF patients and the need for device therapy, Dr. Hoshiar Abdollah provides electrophysiology expertise from within the Heart Function Clinic, which streamlines management of patients with combined HF and arrhythmias. Dr. Aws Almufleh brings leadership and passion for quality improvement. He is the Specialist Representative for the KFL-Ontario Health Team (OHT) HF pathway aimed at supporting primary care providers (PCPs) in diagnosing and managing HF. Soon, the clinic will welcome Dr. Josh Durbin, who will be a strong asset given his dual training in advanced echocardiography and pulmonary hypertension.

Finally, the clinic has modernized its follow-up operations in response to the COVID-19 pandemic by ramping up telephone/virtual follow-up and medication titration. In 2022, the KHSC Heart Function Clinic provided over 5000 clinical visits (both in-person and telephone).

How would you describe the importance of this clinic for patients in our community? Heart failure patients are a vulnerable group. Many are elderly, have multiple comorbidities, and are on many medications. The treatment of HF starts with patient education, lifestyle modification and instituting guidelines-directed medical therapy. The Heart Function Clinic provides an ideal venue to see these patients early, to provide education and empower patients to engage in self-care, then introduce medical therapy. In a way, the Heart Function Clinic serves as the “safety valve” that offers comprehensive care to HF patients, which reduces their risk of ED visits and HF admissions and ultimately improves their quality of life and survival.

In addition to clinical care, the clinic is positioned to provide education (to residents, fellows, and nurse practitioner students), to become active in clinical research, and to support/guide primary care providers in the community. Thus, the impact of the Heart Function Clinic goes beyond individual patients referred to the clinic, and has the potential to reach the community via education and supporting primary care providers in diagnosing and managing HF.

Can you give an example of how the Heart Function Clinic impacted the lives of patients in Kingston?Building the cardiac amyloidosis program locally at the Heart Function Clinic is a good example of the impact of the Heart Function Clinic on the community.

Amyloidosis is a serious condition caused by the accumulation of misfolded proteins throughout the body, including the heart muscle. This can lead to congestive heart failure symptoms including shortness of breath, fatigue, and leg edema.

These symptoms are non-specific, making cardiac amyloidosis especially difficult to diagnose. Also, because the disease can affect any organ in the body, diagnosis requires comprehensive patient assessment, several investigations, at times including heart biopsy. Work-up and treatment used to be offered only in Toronto or Ottawa, so our patients had to wait many months (sometimes over a year) to be seen there and then drive several times a year for follow-up.

As of 2021, we started caring for patients with cardiac amyloidosis at the Heart Function Clinic at KHSC. We now perform all the tests required locally, apply to the Ministry of Health to secure medication coverage, initiate the treatment, and provide close follow-up for cardiac amyloidosis. The decreased wait-times, which is crucial as early detection and treatment of amyloidosis, can substantially improve clinical outcomes. Several patients shared with us the relief they felt when they were told they no longer needed to drive to Toronto to receive this care.

Of course, this would not be possible without the dedication of the Heart Function Clinic nurse practitioners who are taking this on in addition to caring for other active and complicated heart failure patients.

Are there future goals you are striving for? We are very proud of the care provided at the Heart Function Clinic and the superb patient outcomes, but no matter how efficient we are, we cannot reach the approximately 10,000 patients living with heart failure in the community. Our goal is to empower primary care providers in the community to take charge of HF diagnosis, initial management and follow-up through education, and the implementation of a HF primary care management pathway.

Ultimately, we define success as when the care received by most patients in the community is equivalent to the care we provide at the Heart Function Clinic. Achieving this high goal will require building capacity at the clinic to provide education and support to our colleagues in the community while they navigate the HF primary care management pathway. We will also need to transform the model of care at the clinic from longitudinal chronic disease follow-up to a model of acute care, decongestion, and medication optimization, then return patients to referring specialists or primary care providers.

This will free the clinic to provide timely care to more vulnerable patients (e.g. post-discharge, patients with worsening symptoms, or patients with specific cardiomyopathies that require the clinic’s expertise like sarcoidosis, amyloidosis, and other infiltrative disorders).

In all these endeavors, we are fortunate to have the support and guidance from the leadership at all levels: the cardiac program management at KHSC, at the Division of Cardiology, and at the Department of Medicine.

Feature: Heart Function Clinic

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Feature: Heart Function Clinic

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