Abstract 13535: Improved Outcomes With Early Collaborative Care of Ambulatory Heart Failure (HF) Patients Discharged From the Emergency Department (ED)
Background: The type of ambulatory physician care after ED visit for HF may affect patients' outcomes. We conducted a population-based outcomes study of all HF patients who visited and were discharged from an ED, examining the type of physician care received within 30 days post-ED discharge.
Methods: Using the National Ambulatory Care Reporting System, we examined the care and outcomes of HF patients who visited and were discharged from ED in Ontario, Canada (April 2004-March 2007). We compared HF patients who received early care after ED discharge by primary care (PC) physician, cardiologist (C), collaborative care by cardiologist and PC (C+PC), or no physician visit (NoMD), and their outcomes using propensity-matched analyses.
Results: Care for 10,599 ED-discharged HF patients (mean age 75±12, 50% male) was provided by PC (n=6596), C (n=535), or by C+PC (n=1478), and 1990 had NoMD. For patients receiving C+PC, C, PC, or NoMD care, C+PC (collaborative care) were more likely to undergo left ventricular function assessment (57.4%, 50.3%, 28.9%, 14.2%, p<0.001), noninvasive stress testing (20.7%, 17.9%, 8.0%, 4.0%, p<0.001), and cardiac catheterization (11.6%, 11.6%, 2.7%, 1.6%, p<0.001) within 100 days post-ED discharge. Drug prescriptions (≥65 years) for C+PC, C, PC, and NoMD demonstrated higher utilization with C+PC or C for ACE inhibitors or ARBs (76.6%, 78.2%, 69.1%, 63.3%, p<0.001), beta-adrenoreceptor antagonists (63.4%, 63.5%, 48.0%, 44.5%, p<0.001), loop diuretics (84.2%, 84.8%, 79.6%, 77.0%, p<0.001), metalozone (4.8%, 5.1%, 3.4%, 3.0%, p<0.001), and spironolactone (19.8%, 17.7%, 12.7%, 12.1%, p<0.001). In a propensity-matched model adjusting for baseline covariates, mortality risk was lower with PC vs NoMD: hazard ratio [HR] 0.75 (95%CI; 0.64–0.87, p<0.001). C+PC further reduced mortality vs PC: HR 0.79 (95%CI; 0.63–1.00, p=0.045). Although PC was not associated with reduction in the composite outcome of all-cause hospitalization, ED visit, or death with HR 0.97 (95%CI; 0.89–1.04, p=0.367), C+PC reduced this risk vs PC: HR 0.86 (95%CI; 0.78–0.94, p=0.001).
Conclusions: Early collaborative HF care was associated with increased use of drug therapies and cardiovascular diagnostic tests, and better outcomes, compared with PC alone.
- © 2010 by American Heart Association, Inc.