Cardiologist-driven heart failure care may improve short-term outcomes

Patients with acute decompensated heart failure may benefit more from care by a cardiologist than a non-cardiologist, according to a study published in the February issue of the American Journal of Cardiology.

Researchers explored outcomes of patients discharged from Catholic Medical Center in Manchester, N.H., a large urban-based community hospital between 2006 and 2007. Discharge for these patients was signed off on by one of three provider types: cardiologists, hospitalists or non-hospitalists. Follow-up on the 496 patients occurred through six months post discharge.

The research team led by Shanmugam Uthamalingam, MD, from Baystate Medical Center in Springfield, Mass., found that, on average, while cardiologists tended to patients who were younger than those cared for by hospitalists, their patients tended to have poorer initial health. Patients of cardiologists more frequently exhibited New York Heart Association class III and IV symptoms compared with hospitalists or non-hospitalists (79.9 percent vs. 59.5 percent vs. 63.3 percent, respectively). Mean left ventricular ejection fraction among patients seen by cardiologists was 22.6 percent. Among patients of hospitalists and non-hospitalists, the mean was 25.5 percent and 27.8 percent, respectively.

They found that cardiologists were most likely to adhere to the Joint Commission Heart Failure core measure for left ventricle assessment, as well (93 percent vs. 78 percent vs. 76 percent, respectively). All cardiologists adhered to the measures on smoking cessation and providing discharge instructions and were more likely to discharge patients with prescriptions of ACEI and/or ARB. Only hospitalists were more likely to prescribe beta blockers and statins, although cardiologists were not far behind.

Ultimately, despite patients with higher risk profiles, patients cared for by cardiologists had lower rates of death at six months compared to hospitalists and non-hospitalists (6 percent, 10.9 percent and 11.4 percent, respectively). Readmission rates were much lower among patients treated by cardiologists (16.2 percent) as opposed to hospitalists (40.1 percent) or non-hospitalists (34.9 percent). Composite death and/or readmission rates for acute decompensated heart failure were less than half those of non-cardiologists.

However, length of stay was longer among patients of cardiologists (6.7 days) than those of hospitalists (5.5 days) and non-hospitalists (5.24 days). Hospital costs were also higher for patients of cardiologists compared to those of noncardiologists, although not significantly so.

Uthamalingam et al noted that their findings were similar to other comparative practice studies, including one comparing outcomes for patients treated by cardiologists against those treated by family physicians. They suggested that improved adherence to Joint Commission Heart Failure core measures may have a hand in driving the improved mortality and readmission rates among patients of cardiologists over non-cardiologists.