Is specialty care associated with improved survival of patients with congestive heart failure?

被引:55
|
作者
Indridason, OS
Coffman, CJ
Oddone, EZ
机构
[1] Durham Vet Affairs Med Ctr, Ctr Hlth Serv Res Primary Care, Durham, NC 27705 USA
[2] Duke Univ, Med Ctr, Div Gen Internal Med, Durham, NC USA
[3] Duke Univ, Med Ctr, Div Nephrol, Dept Med, Durham, NC 27706 USA
关键词
D O I
10.1067/mhj.2003.54
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Implementation of the complex treatment strategies that have been shown to improve survival of patients with congestive heart failure (CHF) may require certain expertise. We wanted to examine the association between pattern of outpatient care and survival of patients with CHF. Methods In a retrospective cohort study conducted with national Veterans Health Administration (VHA) databases, we examined the association between the pattern of outpatient care and survival in 11,661 patients discharged from VA hospitals between October 1, 1991, and September 30, 1992, with the primary diagnosis of CHF (cohort 1). Patients were divided into 4 groups, on the basis of their pattern of outpatient care over a 12-month period after discharge: 1) general medicine clinic visits only (GM-only); 2) cardiology clinic visits only (CARD-only); 3) general medicine and cardiology (MIXED) clinic visits; and 4) neither general medicine nor cardiology clinic visits (no-GM/CARD). We used the Cox proportional hazards model to evaluate 1-year survival, controlling for clinical and demographic factors. Consistency of our results was examined by performing identical analysis on a cohort of patients discharged from VHA hospitals between October 1, 1994, and September 30, 1995 (cohort 2, n 10, 141). Results The overall 1-year mortality rate was 23% in the primary cohort. The unadjusted mortality rate was highest for patients in the no-GM/CARD follow up (29%) and lowest for patients in the MIXED group (19%). By use of the MIXED group as reference and adjusting for important clinical and demographic factors, the risk of death (risk ratio [95% CI]) was 1.12 (0.94-1.34) in the CARD-only group, 1.26 (1.15-1.38) in the GM-only group, and 1.48 (1.28-172) in the no-GM/CARD group. Cohort-2 results were consistent with cohort 1 for most covariates, and significant survival differences were again found between GM-only and the MIXED group (1.25 [1.14-1.37]). Conclusions We found an improved survival associated with cardiologist care and a mixture of general practitioner and cardiologist care compared with general practitioner care. The pattern of outpatient care may therefore be important for the survival of patients with CHF.
引用
收藏
页码:300 / 309
页数:10
相关论文
共 50 条
  • [1] Improved Care for Patients with Congestive Heart Failure
    Jacobsen, Diane
    Sevin, Cory
    [J]. JOINT COMMISSION JOURNAL ON QUALITY AND PATIENT SAFETY, 2008, 34 (01): : 13 - 19
  • [2] Resource use and survival of patients hospitalized with congestive heart failure: Differences in care by specialty of the attending physician
    Auerbach, AD
    Hamel, MB
    Davis, RB
    Connors, AF
    Regueiro, C
    Desbiens, N
    Goldman, L
    Califf, RM
    Dawson, NV
    Wenger, N
    Vidaillet, H
    Phillips, RS
    [J]. ANNALS OF INTERNAL MEDICINE, 2000, 132 (03) : 191 - 200
  • [3] SURVIVAL OF PATIENTS WITH CONGESTIVE HEART-FAILURE
    HOBBIE, RK
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1972, 286 (11): : 606 - &
  • [4] Quality of care of patients admitted with congestive heart failure: Influence of physician specialty and hospital type
    Amin, JK
    Lim, MJ
    Almanaseer, Y
    Pai, CW
    Finnegan, G
    Eagle, KA
    Mehta, RH
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (05) : 452A - 452A
  • [5] Mortality associated with the quality of care of patients hospitalized with congestive heart failure
    Luthi, JC
    McClellan, WM
    Fitzgerald, D
    Krumholz, HM
    Delaney, RJ
    Bratzler, DW
    Elward, K
    Cangialose, CB
    Ballard, DJ
    [J]. INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, 2002, 14 (01) : 15 - 24
  • [6] Higher Doses of Spirinolactone Are Associated with Lower Survival in Patients with Congestive Heart Failure
    Shore, S.
    Aggarwal, V.
    Zolty, R.
    [J]. JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2011, 30 (04): : S78 - S78
  • [7] Renal artery intervention is associated with improved heart failure control in patients with congestive heart failure and renovascular hypertension
    Kane, GC
    Xu, NN
    Garovic, VD
    [J]. CIRCULATION, 2005, 112 (17) : U409 - U409
  • [8] Estrogen is associated with improved survival in aging women with congestive heart failure: Analysis of the vesnarinone studies
    Reis, SE
    Holubkov, R
    Young, JB
    White, BG
    Cohn, JN
    Feldman, AM
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2000, 36 (02) : 529 - +
  • [9] SURVIVAL OF PATIENTS WITH CONGESTIVE HEART-FAILURE - REPLY
    MCKEE, PA
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1972, 286 (11): : 607 - &
  • [10] Improvement of Anemia is Associated with Improved Survival in Elderly Heart Failure Patients
    Ortiz, J.
    Mendez, M.
    Nieto, S.
    Munoz, N.
    Renieblas, P.
    Sanchez, C.
    Perez, A.
    Audibert, L.
    [J]. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2009, 57 : S155 - S155