Published online before print June 23, 2003, doi: 10.1161/01.CIR.0000080290.39027.48
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;108:184.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists
From the Heart & Stroke/Richard Lewar Centre of Excellence (P.J., P.P.L.); Division of Cardiology (P.J., P.P.L.), Toronto General Hospital, University Health Network; Institute for Clinical Evaluative Sciences (P.J., Y.G., P.C.A., D.S.L., J.V.T.); Department of Public Health Sciences (P.C.A., J.V.T.), University of Toronto; and Division of General Internal Medicine and the Clinical Epidemiology and Health Care Research Program (J.V.T.), Sunnybrook and Women’s College Health Sciences Centre, Toronto, Ontario, Canada.
Correspondence to Jack V. Tu, MD, PhD, Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. E-mail tu{at}ices.on.ca
Background— It is not known whether subspecialty care by cardiologists improves outcomes in heart failure patients from the community over care by other physicians.
Methods and Results— Using administrative data, we monitored 38 702 consecutive patients with first-time hospitalization for heart failure in Ontario, Canada, between April 1994 and March 1996 and examined differences in processes of care and clinical outcomes between patients attended by physicians of different disciplines. We found that patients attended by cardiologists had lower 1-year risk-adjusted mortality than those attended by general internists, family practitioners, and other physicians (28.5% versus 31.7%, 34.9%, and 35.9%, respectively; all pairwise comparisons, P<0.001). The 1-year risk-adjusted composite outcome of death and readmission for heart failure was also lower for the cardiologists compared with family practitioners and other physicians but not general internists (54.7% versus 58.1%, 58.3%, and 55.4%; P<0.001, P<0.001, and P=0.39, respectively). Multivariable hierarchical modeling demonstrated a significant physician-level effect for both outcomes in favor of the cardiologists, particularly against non-general internists. Cardiologist care was associated with higher adjusted rates of invasive interventions and postdischarge prescriptions of heart failure medications.
Conclusions— In this population-based cohort, heart failure patients attended by cardiologists in hospital had lower risk of death as well as the composite risk of death or readmission than patients attended by noncardiologists. These data raise the need to identify specialty-driven differences in processes of care for heart failure patients, which may explain the observed disparity in clinical outcomes that presently favor cardiologist care.
Key Words: heart failure • prognosis • population • mortality • morbidity
Related Article:
Circulation 2003 108: 129-131.
This article has been cited by other articles:
 |
|
 |
|
  N. M. Hawkins, M. C. Petrie, P. S. Jhund, G. W. Chalmers, F. G. Dunn, and J. J.V. McMurray Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology Eur J Heart Fail, February 1, 2009; 11(2): 130 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Keyhan, S.-F. Chen, and L. Pilote Angiotensin-converting enzyme inhibitors and survival in women and men with heart failure Eur J Heart Fail, June 1, 2007; 9(6-7): 594 - 601. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hudson, E. Rahme, H. Behlouli, R. Sheppard, and L. Pilote Sex differences in the effectiveness of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in patients with congestive heart failure -- A population study Eur J Heart Fail, June 1, 2007; 9(6-7): 602 - 609. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Saposnik and M. K. Kapral Poststroke Care: Chronicles of a Neglected Battle Stroke, June 1, 2007; 38(6): 1727 - 1729. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Follath Beta-blockade today: the gap between evidence and practice Eur. Heart J. Suppl., June 1, 2006; 8(suppl_C): C28 - C34. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. D Gillespie The diagnosis and management of chronic heart failure in the older patient Br. Med. Bull., February 22, 2006; 75-76(1): 49 - 62. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Squire Managing patients with heart failure: the reality of clinical practice Eur. Heart J., December 2, 2005; 26(24): 2611 - 2613. [Full Text] [PDF]
|
|
|
|
|
|
R. Roccaforte, C. Demers, F. Baldassarre, K. K.Teo, and S. Yusuf Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis Eur J Heart Fail, December 1, 2005; 7(7): 1133 - 1144. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Ko, J. V. Tu, F. A. Masoudi, Y. Wang, E. P. Havranek, S. S. Rathore, A. M. Newman, L. R. Donovan, D. S. Lee, J. M. Foody, et al. Quality of Care and Outcomes of Older Patients With Heart Failure Hospitalized in the United States and Canada Arch Intern Med, November 28, 2005; 165(21): 2486 - 2492. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Hudson, H. Richard, and L. Pilote Differences in outcomes of patients with congestive heart failure prescribed celecoxib, rofecoxib, or non-steroidal anti-inflammatory drugs: population based study BMJ, June 11, 2005; 330(7504): 1370. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S J Leslie, S P McKee, E A Imray, and M A Denvir Management of chronic heart failure: perceived needs of general practitioners in light of the new general medical services contract Postgrad. Med. J., May 1, 2005; 81(955): 321 - 326. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Bernatsky, M. Hudson, and S. Suissa Anti-rheumatic drug use and risk of hospitalization for congestive heart failure in rheumatoid arthritis Rheumatology, May 1, 2005; 44(5): 677 - 680. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Ezekowitz, C. van Walraven, F. A. McAlister, P. W. Armstrong, and P. Kaul Impact of specialist follow-up in outpatients with congestive heart failure Can. Med. Assoc. J., January 18, 2005; 172(2): 189 - 194. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. G. Ray, Y. Gong, K. Sykora, and J. V. Tu Statin Use and Survival Outcomes in Elderly Patients With Heart Failure Arch Intern Med, January 10, 2005; 165(1): 62 - 67. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. M. Califf, T. Ryan, P. Douglas, and P. J. Goldschmidt-Clermont A time of accelerated change in academic cardiovascular medicine: Implications for academic divisions of cardiology and their training programs J. Am. Coll. Cardiol., November 16, 2004; 44(10): 1957 - 1965. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gustafsson and J. M. O. Arnold Heart failure clinics and outpatient management: review of the evidence and call for quality assurance Eur. Heart J., September 2, 2004; 25(18): 1596 - 1604. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. N. Juurlink, M. M. Mamdani, D. S. Lee, A. Kopp, P. C. Austin, A. Laupacis, and D. A. Redelmeier Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study N. Engl. J. Med., August 5, 2004; 351(6): 543 - 551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. B. Fye Introduction: the origins and implications of a growing shortage of cardiologists J. Am. Coll. Cardiol., July 21, 2004; 44(2): 221 - 232. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hirshfeld Jr and W. B. Fye Summary of Task Force recommendations to address the growing shortage of cardiologists J. Am. Coll. Cardiol., July 21, 2004; 44(2): 272 - 275. [Full Text] [PDF]
|
|
|
|
|
|
S. R. Majumdar, F. A. McAlister, and C. D. Furberg From knowledge to practice in chronic cardiovascular disease: a long and winding road J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1738 - 1742. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. T. Ko, M. Mamdani, and D. A. Alter Lipid-Lowering Therapy With Statins in High-Risk Elderly Patients: The Treatment-Risk Paradox JAMA, April 21, 2004; 291(15): 1864 - 1870. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. P. Coletta, A. L. Clark, A.-M. L. Seymour, and J. G.F. Cleland Clinical trials update from the European Society of Cardiology Heart Failure meeting: COMET, COMPANION, Tezosentan and SHAPE Eur J Heart Fail, August 1, 2003; 5(4): 545 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Kim and S. A. Hunt Heart Failure Management: Caregiver Versus Care Plan Circulation, July 15, 2003; 108(2): 129 - 131. [Full Text] [PDF]
|
|