Abstract 12910: The Utility of Automatic Cardiology Referral for Patients With Heart Failure at a Tertiary Academic Medical Center: The Automated MEdical Record driven Implantable CArdioverter-defibrillator Heart Failure Pilot Study (AMERICA-HF Study)
Introduction: Patients with heart failure (HF) receive guideline-recommended therapies more frequently when treated by specialists in cardiology. However, a significant percentage of HF patients are not referred to cardiology. In addition, implantable cardioverter defibrillator (ICD) therapy remains underutilized in the general HF population.
Hypothesis: Automatic referral of patients with HF to a general cardiologist or electrophysiologist using the electronic medical record (EMR) improves utilization of guideline-recommended therapies.
Methods: In this pilot study, we determined the proportion of HF patients actively receiving outpatient cardiology care at our institution and assessed the utilization of guideline-recommended therapies. Patients with a prior diagnosis of HF who underwent an echocardiogram within the Duke University Health System between August 1, 2013 and July 31, 2014 were identified by retrospective EMR search. Patients with an ejection fraction >35% and those deceased at the time of EMR search were excluded. Patients were classified as “cardiology care” based on the attendance of at least one outpatient cardiology visit during the year prior to the echocardiogram or sooner; all other patients were classified as “no cardiology care”. Utilization of medical and device-based HF therapies were assessed in both groups.
Results: A total of 1151 patients with a prior diagnosis of HF underwent an echocardiogram during the specified time period. Of these, 425 were eligible for the study. The majority of patients (n=388, 91%) were found to be receiving care from a cardiology provider. Patients receiving cardiology care were more likely to be treated with beta blockers (84% vs. 46%, p<0.0001), ACE inhibitors/ARBs (76% vs. 57%, p=0.01), aldosterone antagonists (52% vs 22%, p<0.0001), and ICDs (71% vs. 38%, p<0.001). In the cardiology care group, the underutilization rate of ICD therapy was 4.4% after accounting for contraindications.
Conclusions: The vast majority of HF patients in this study were actively receiving cardiology care. In addition, appropriate ICD utilization was very high in patients managed by cardiology. Therefore, an automatic referral process would be unlikely to improve HF care at our institution.
Author Disclosures: A.S. Barnett: None. A. Sun: None. J. Koontz: None. Z.J. Eapen: None. C.B. Patel: None. E.J. Velazquez: None. B.D. Atwater: Research Grant; Modest; Medtronic, Boston Scientific, St. Jude.
- © 2015 by American Heart Association, Inc.