Ecole de réadaptation, Université de Montréal, Montreal, Canada.
Can J Cardiol. 2009 Dec;25(12):690-4. doi: 10.1016/s0828-282x(09)70528-8.
It is recommended that persons recently diagnosed with heart failure consult with a specialist in heart failure.
To determine whether patients who were diagnosed with new-onset chronic heart failure (CHF) by a noncardiologist consulted with a cardiologist, and identify the factors associated with delayed consultation.
Physician reimbursement administrative data were obtained for all adults with suspected new-onset CHF in the year 2000 in Quebec, defined operationally as a physician visit for CHF (based on the International Classification of Diseases, 9th Revision diagnostic codes), with no previous physician visit code for CHF in the preceding three years. Among those first diagnosed by a noncardiologist, Cox regression modelling was used to identify patient and physician characteristics associated with time to cardiology consultation.
Of the 13,523 persons coded as having incident CHF, 54.9% consulted a cardiologist within the next 2.5 to 3.5 years, and 67.4% were seen by an internist or cardiologist. Older patients, women, and those with lower comorbidity and socioeconomic status had significantly longer times to cardiology consultation.
The data suggest that many patients with suspected new-onset CHF do not receive prompt cardiology care, as stipulated by current recommendations. Equity of access for women and those with lower socioeconomic status appears to be problematic.
建议近期被诊断为心力衰竭的患者咨询心力衰竭方面的专家。
确定非心脏病专家诊断为新发慢性心力衰竭（CHF）的患者是否咨询了心脏病专家，并确定与延迟咨询相关的因素。
获取了 2000 年魁北克所有疑似新发 CHF 成人的医生报销管理数据，根据国际疾病分类第 9 版（ICD-9）诊断代码，将其定义为心力衰竭就诊（无既往 3 年内的心力衰竭就诊代码）。在首次由非心脏病专家诊断的患者中，采用 Cox 回归模型确定与心脏病学咨询时间相关的患者和医生特征。
在编码为新发 CHF 的 13523 人中，54.9%在接下来的 2.5 至 3.5 年内咨询了心脏病专家，67.4%由内科医生或心脏病专家就诊。年龄较大的患者、女性以及合并症和社会经济地位较低的患者，心脏病学咨询时间明显延长。
数据表明，许多疑似新发 CHF 的患者没有按照当前建议及时接受心脏病学治疗。女性和社会经济地位较低的患者的公平获得机会似乎存在问题。
