Uthamalingam Shanmugam, Kandala Jagdesh, Selvaraj Vijairam, Martin William, Daley Marlyn, Patvardhan Eshan, Capodilupo Robert, Moore Stephanie, Januzzi James L
Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts.
Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, Arizona.
Am J Cardiol. 2015 Feb 15;115(4):466-71. doi: 10.1016/j.amjcard.2014.11.034. Epub 2014 Dec 2.
Physician practice patterns in the management of hospitalized acute decompensated heart failure (ADHF) patients may vary by specialty; comparative practice patterns in ADHF management and clinical outcomes as a function of provider type have not been well reported. We studied a total of 496 patients discharged with the principal diagnosis of ADHF to analyze practice patterns among 3 provider types (cardiologists, hospitalists, and nonhospitalists). We examined outcomes of death and rehospitalization for HF and adherence to the Joint Commission HF performance core measures. Cardiologists had the highest adherence in all 4 HF core measures compared with hospitalists and nonhospitalists. At 6 months, 6.0% of the patients cared by cardiologists died compared with 10.9% and 11.4% cared by hospitalist and nonhospitalists (p = 0.12). Patients cared for by cardiologists had a significantly lower 6-month ADHF readmission rate (16.2%) compared with hospitalists (40.1%) and nonhospitalists (34.9%, p <0.001). In multivariate analysis, both hospitalist and nonhospitalist provider types were an independent predictor for 6-month ADHF-related readmission (hospitalists vs cardiologists, hazard ratioadjusted 3.01; 95% confidence interval 1.84 to 4.89, p <0.001; and nonhospitalists vs cardiologists, hazard ratioadjusted 2.07; 95% confidence interval 1.24 to 3.46, p = 0.005). In conclusion, cardiologist-delivered ADHF care is associated with greater adherence to HF core measures and with significantly lower rates of adverse outcome compared with noncardiologists.
住院急性失代偿性心力衰竭（ADHF）患者的医生治疗模式可能因专业不同而有所差异；关于ADHF管理中的比较治疗模式以及作为提供者类型函数的临床结局，尚未有充分报道。我们共研究了496例以ADHF为主要诊断出院的患者，以分析3种提供者类型（心脏病专家、住院医师和非住院医师）的治疗模式。我们检查了心力衰竭的死亡和再住院结局以及对联合委员会心力衰竭绩效核心指标的依从性。与住院医师和非住院医师相比，心脏病专家在所有4项心力衰竭核心指标上的依从性最高。在6个月时，由心脏病专家治疗的患者中有6.0%死亡，而由住院医师和非住院医师治疗的患者中这一比例分别为10.9%和11.4%（p = 0.12）。与住院医师（40.1%）和非住院医师（34.9%）相比，由心脏病专家治疗的患者6个月ADHF再入院率显著更低（16.2%，p<0.001）。在多变量分析中，住院医师和非住院医师提供者类型均是6个月ADHF相关再入院的独立预测因素（住院医师与心脏病专家相比，调整后的风险比为3.01；95%置信区间为1.84至4.89，p<0.001；非住院医师与心脏病专家相比，调整后的风险比为2.07；95%置信区间为1.24至3.46，p = 0.005）。总之，与非心脏病专家相比，心脏病专家提供的ADHF治疗与对心力衰竭核心指标的更高依从性以及更低的不良结局发生率相关。
