Marques André C, Calderaro Daniela, Yu Pai C, Gualandro Danielle M, Carmo Gabriel A L, Azevedo Fernanda R, Pastana Adriana F, Lima Eneas M O, Monachini Maristela, Caramelli Bruno
Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
Centro de Cardiologia, Hospital Sírio Libanês, São Paulo, SP, Brazil.
Clinics (Sao Paulo). 2014 Dec;69(10):666-71. doi: 10.6061/clinics/2014(10)03.
Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations.
We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected.
Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99).
Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.
因非心脏疾病入院的患者中，心内科会诊很常见。心内科医生的建议可能涉及复杂且积极的治疗，而其他医生可能会忽视或拒绝这些建议。本研究的目的是比较在心内科会诊时接受建议的患者的结局，并检查未遵循建议的患者的临床结局。
我们纳入了589例连续接受院内心内科会诊的患者。收集了关于建议、建议实施情况和结局的数据。
关于转诊科室对建议的遵循情况，77%的患者被归类为遵循组，23%被归类为不遵循组。不遵循组（p<0.001；比值比：10.25；95%置信区间：4.45 - 23.62）和高龄（p = 0.017；OR：1.04；95%置信区间：1.01 - 1.07）与不良结局相关。多因素分析确定了四个遵循建议的独立预测因素：病历中的随访记录（p<0.001；OR：2.43；95%置信区间：1.48 - 4.01）；口头强化（p = 0.001；OR：1.86；95%置信区间：1.23 - 2.81）；少量建议（p = 0.001；OR：0.87；95%置信区间：0.80 - 0.94）；以及患者年龄较轻（p = 0.002；OR：0.98；95%置信区间：0.96 - 0.99）。
心内科转诊建议的依从性差与不良临床结局相关。病历中的随访记录、口头强化、有限数量的建议和患者年龄与更高的建议依从性相关。
