Improved Outcomes With Early Collaborative Care of Ambulatory Heart Failure Patients Discharged From the Emergency Department

被引:155
作者
Lee, Douglas S. [1 ,2 ,3 ]
Stukel, Therese A. [2 ,4 ]
Austin, Peter C. [2 ,4 ]
Alter, David A. [2 ]
Schull, Michael J. [2 ,5 ]
You, John J. [2 ,6 ]
Chong, Alice [2 ]
Henry, David [2 ]
Tu, Jack V. [2 ,4 ,5 ]
机构
[1] Univ Toronto, Inst Clin Evaluat Sci, Toronto, ON M4N 3M5, Canada
[2] Toronto Gen Hosp, Inst Clin Evaluat Sci, Toronto, ON, Canada
[3] Univ Hlth Network, Toronto, ON, Canada
[4] Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
[5] Sunnybrook Hlth Sci Ctr, Toronto, ON M4N 3M5, Canada
[6] McMaster Univ, Hamilton Gen Hosp, Toronto, ON, Canada
基金
加拿大健康研究院;
关键词
emergency care; heart failure; morbidity; mortality; PROFILING HOSPITAL PERFORMANCE; OLDER PATIENTS; PHYSICIANS; MANAGEMENT; MORTALITY; CARDIOLOGISTS; DIAGNOSIS; RECOMMENDATIONS; ASSOCIATION; SPECIALTY;
D O I
10.1161/CIRCULATIONAHA.110.940262
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The type of outpatient physician care after an emergency department visit for heart failure may affect patients' outcomes. Methods and Results-Using the National Ambulatory Care Reporting System, we examined the care and outcomes of heart failure patients who visited and were discharged from the emergency department in Ontario, Canada (April 2004 to March 2007). Early collaborative care by a cardiologist and primary care (PC) physician within 30 days after discharge was compared with PC alone. Care for 10 599 patients (age, 74.9 +/- 11.9 years; 50.2% male) was provided by PC alone (n = 6596), cardiologist alone (n = 535), or concurrently by both cardiologist and PC (n = 1478); 1990 did not visit a physician. Collaborative care patients were more likely to undergo assessment of left ventricular function (57.4% versus 28.7%), noninvasive stress testing (20.1% versus 7.8%), and cardiac catheterization (11.6% versus 2.7%) compared with PC. Drug prescriptions (patients >= 65 years of age) demonstrated higher use of angiotensin-converting enzyme inhibitors (58.8% versus 54.6%), angiotensin receptor blockers (22.7% versus 18.1%), beta-adrenoceptor antagonists (63.4% versus 48.0%), loop diuretics (84.2% versus 79.6%), metolazone (4.8% versus 3.4%), and spironolactone (19.8% versus 12.7%) within 100 days after emergency department discharge for collaborative care compared with PC. In a propensity-matched model, mortality was lower with PC compared with no physician visit (hazard ratio, 0.75; 95% confidence interval, 0.64 to 0.87; P < 0.001). Collaborative care reduced mortality compared with PC (hazard ratio, 0.79; 95% confidence interval, 0.63 to 1.00; P = 0.045). Sole cardiology care conferred a trend to increased mortality (hazard ratio, 1.41 versus collaborative care; 95% confidence interval, 0.98 to 2.03; P = 0.067). Conclusions-Early collaborative heart failure care was associated with increased use of drug therapies and cardiovascular diagnostic tests and better outcomes compared with PC alone. (Circulation. 2010;122:1806-1814.)
引用
收藏
页码:1806 / +
页数:25
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