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St. Joseph's Health Centre Toronto

Out of the emergency room and into the Rapid Heart Failure Clinic

By Madison Thakore

Dr. Peter Mitoff and Jennifer Comello

A patient enters the emergency department experiencing swelling and shortness of breath. Usually, the physician would consider two options for patients presenting signs of heart failure such as these: admit the patient or discharge them for future treatment by a family doctor.

Now, with the Rapid Heart Failure Clinic at St. Joseph’s Health Centre, there’s another option. Cardiologist Dr. Peter Mitoff and the clinic’s team provide alternative treatment for low-risk heart failure patients. Patient status is determined by emergency department physicians using a risk score calculator, which provides a seven-day and 30-day risk analysis of hospitalization and mortality rates

If a patient is considered low-risk, they are discharged and advised to follow up with the clinic within 48 to 72 hours, where they continue to receive treatment for about 30 days. If they are high-risk, they are admitted for treatment.

In operation since January as one of ten sites participating in the Comparison of Outcomes and Access to Care for Heart Failure (COACH) trial, the Rapid Heart Failure Clinic aims to improve care and reduce emergency department readmission.

“We’re able to take more time to delve into our patients’ health history and risk factors,” says  registered nurse and nurse navigator Jennifer Comello. “This allows us to expedite testing and appointments to help keep people out of the emergency room.”

Dr. Mitoff explains that as a community teaching hospital, the clinic offers St. Joseph’s an exciting opportunity to improve patient care and better manage hospital resources.

“We tend to gravitate towards projects that will make a meaningful difference in the care of patients we look after,” says Dr. Mitoff. “What really motivated us to participate in this trial is that it seemed good for patient care and offered us an opportunity to improve our own practices.”

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