Collaborative HF care trumps sole physician care
MedWire News: Heart failure (HF) patients who receive early collaborative care from a cardiologist and a primary care physician have better clinical outcomes than those who receive care from a primary care (PC) physician alone, a large Canadian study indicates.
"Among those who survived the first 30 days after emergency department (ED) discharge, early collaborative care resulted in improved use of diagnostic tests, interventions, and cardiovascular medications compared with PC alone," explain the study authors.
The team, led by Douglas Lee (University of Toronto, Ontario, Canada), investigated the outcomes of 10,599 HF patients discharged from an ED in Ontario between 2004 and 2007.
All patients received care from a PC physician alone (n=6596), cardiologist alone (n=535), PC physician and a cardiologist concurrently (n=1478), or no physician (n=1990) within 30 days of discharge.
Writing in the journal Circulation, Lee and team report that on propensity-matched analysis, patients who received collaborative care had a 21% and 41% lower mortality risk than those who received care from a PC physician or cardiologist alone, respectively (p<0.001, p=0.045, respectively).
Furthermore, the combined outcome of all-cause hospitalization, ED visit, and mortality risk was 14% lower among patients who received collaborative care compared with those who received PC physician care alone (p=0.001).
A lower risk for composite HF-related ED visits, HF-related hospitalizations, and all-cause mortality was also observed among patients who received collaborative care when compared with those who received either PC physician or cardiologist care alone, but this finding was not significant.
"Patients who are discharged home from the ED are vulnerable to recurrent morbid events and death but are often left to navigate the healthcare system with variable degrees of medical guidance," explain the study authors.
In a related editorial, Marco Metra (University of Brescia, Italy) and Robert Bonow (Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA) likened the benefit size of early collaborative treatment "to that shown with neurohormonal antagonists or devices prescribed to treat HF."
Lee et al conclude: "Early physician involvement using a collaborative approach may lead to improved care quality and a substantial reduction in mortality and morbidity in the post-ED context."
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By Lauretta Ihonor