Lessons learned from a multidisciplinary heart failure clinic for older women: a randomised controlled trial

Background: many heart failure disease management programs are primarily conducted in the male population. An approach incorporating disciplines such as physiotherapy, occupational therapy, social work, dietary and pharmacy in a standardized clinical pathway merits further investigation in older women with HF. Methods: in this randomized controlled trial, female patients in the intervention group received the multidisciplinary clinical pathway consisting of a series of 12 visits over a 6-week period in an outpatient clinic. Results: ninety-one community dwelling female patients aged 63 to 89 were randomized. Comparison of change between the two groups from baseline in the Minnesota Living with Heart Failure Questionnaire score did not show a difference (P<0.470). There was also no difference between the two groups in functional outcome as measured by change from baseline by the Physical Self-Maintenance Scale (P<0.321). The treatment group had significantly more hospitalizations, and cardiologist visits during the study period (P<0.0001). Conclusion: It is feasible to conduct a randomized study in a frail community-based older female population and to test a complex multidisciplinary pathway. Future studies should provide insight into the optimal intensity and duration of heart failure management programs with optimal targeting.