HF patients receive best care from cardiologists
MedWire News: In-hospital cardiologist care is associated with improved clinical outcomes in heart failure (HF) patients compared with generalist care alone, an analysis shows.
HF patients who are treated by a cardiologist are more likely to be prescribed medications at discharge and have better survival rates than those treated by a generalist physician alone, report Jack Tu (Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada) and colleagues in the American Heart Journal.
Their study involved 7634 patients who were newly hospitalized for HF in Ontario, Canada, and were enrolled in the Enhanced Feedback for Effective Cardiac Treatment (EFFECT) study between April 2004 and March 2005. All patients were categorized according to whether they received cardiologist care (20.0%), generalist care with a cardiology consult (15.9%), or generalist care without a cardiology consult (64.2%).
Multivariate analysis revealed that patients treated by a generalist alone had a 50% higher risk for 30-day mortality and a 29% higher risk for 1-year mortality than patients who were treated by a cardiologist (p=0.001 for both).
Patients treated by a generalist care without a cardiologist consult had an 18% higher risk for the 1-year composite of death and readmission than those treated by a cardiologist (p=0.025), whereas those who were treated by a generalist with a cardiologist consult had a nonsignificant 13% higher risk.
After excluding patients with do-not-resuscitate orders, the increased risk for 30-day mortality and 1-year composite outcomes were no longer significant.
Further analysis showed that patients who were treated by a generalist alone versus a cardiologist alone received significantly fewer prescriptions for beta blockers (50.2 vs 67.9%), clopidogrel (10.1 vs 15.6%), lipid lowering drugs (38.5 vs 54.8%), and warfarin (29.8 vs 36.2%) at discharge.
"Because HF is such a common problem, it is not possible to have cardiologists involved in the care of all patients; as such improving outcomes in patients with HF treated by generalist physicians is an important objective," state Tu and team.
"Our findings suggest that a greater focus on encouraging generalist physicians to use certain therapies, such as beta blockers, may be an effective strategy in reducing specialty-related differences in patient outcomes," they conclude.
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By Piriya Mahendra