Abstract 12563: Variation in Referral for Specialist Follow-Up and 30-Day Mortality in Patients Hospitalized With Heart Failure in England and Wales
Introduction: Current US and European guidelines recommend that patients hospitalized with heart failure (HF) are followed up after discharge, but do not specify whether or not this should be with HF specialist services. We investigated referral patterns to specialist services amongst hospitals in England and Wales and assessed whether these differences were associated with 30-day mortality.
Methods: We used data from the National Heart Failure Audit, which included 84647 HF patients from 176 hospitals. Vital status was obtained from the UK national death registry. Using hierarchical statistical models and instrumental variable analysis, we estimated whether different types of follow-up (cardiologist, HF nurse or geriatrician) were associated with 30-day mortality, adjusting for case mix.
Results: At the hospital level, rates of referral to cardiologists for follow up varied from 4% to 94%, to HF nurses from 0% to 97% and to geriatricians from 0% to 65%. When heart failure patients were referred for follow-up to a heart failure nurse, to a geriatrician, or to a cardiologist, they were 15%, 15% and 47% less likely to die than patients who were not referred to these specialists (odds ratio [OR] = 0.85, p<0.001; OR = 0.85, p<0.001; OR = 0.53, p<0.001). A patient admitted to one randomly selected UK hospital would have, on average, 2.1-fold odds of receiving referral to a cardiologist for follow up than a second similar patient admitted to another randomly selected hospital (95% confidence interval [CI]: 1.9, 2.3) Use of quintile of hospital preference as an instrumental variable for cardiology referral resulted in a consistent estimate for the effect of cardiology referral on 30-day mortality (OR=0.65, CI: 0.40, 0.90, p=0.005).
Conclusion: Referral at discharge to cardiology services for follow-up varies considerably amongst UK hospitals. At both an individual patient and at a hospital level, referral to cardiology for follow-up is a major determinant of 30-day mortality.
Author Disclosures: K. Rahimi: None. C.A. Emdin: None. J.G. Cleland: None. H. Dargie: None. R. Korshidi: None. S. Hardman: None. M. Woodward: None. S. MacMahon: None. P. Mitchell: None. T. McDonagh: None.
- © 2014 by American Heart Association, Inc.