Community Care, Unnan City Hospital, 96-1 Iida, Daito-Cho, Unnan, Shimane, 699-1221, Japan.
Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan.
BMC Prim Care. 2024 Sep 5;25(1):330. doi: 10.1186/s12875-024-02558-3.
The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates.
This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors.
A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio [OR], 0.62) and hospitalization (OR, 0.73).
In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities.
由于人口老龄化，心力衰竭的患病率不断增加，导致医疗费用不断增加，同时患有多种疾病的患者人数也在增加。除了内科医生（如心脏病专家）之外，全科医生对心力衰竭的最佳管理也至关重要，尽管具体情况尚不清楚。在这项研究中，我们旨在确定老年心力衰竭患者由全科医生和内科医生管理的结果差异，特别是在住院率和死亡率方面。
这是一项在日本社区医院就诊的心力衰竭患者的回顾性队列研究。从电子病历数据中根据国际疾病分类代码选择心力衰竭患者，时间跨度为 9 年，从 2015 年 9 月到 2023 年 8 月。自变量为是否由全科医生治疗患者；主要结局为死亡；次要结局为住院；协变量为患者背景，包括合并症。使用多变量逻辑回归分析评估在调整混杂因素后，由全科医生治疗与死亡和住院的关联。
共确定了 1032 例心力衰竭患者，平均年龄为 82.4 岁，48.9%为男性。由全科医生治疗的患者年龄更大，更有可能患有痴呆症，并且比由内科医生治疗的患者更需要护理。由全科医生治疗与死亡（优势比 [OR]，0.62）和住院（OR，0.73）显著负相关。
在日本，医学专业日益分化，全科医生对患有心力衰竭和多种合并症的老年患者进行全面管理，可能会降低住院率和死亡率。适当教育全科医生并增加他们的数量可能对老龄化社区心力衰竭患者的成功管理至关重要。
