Format

Send to

Choose Destination
Rev Esp Cardiol (Engl Ed). 2017 May;70(5):347-354. doi: 10.1016/j.rec.2016.12.026. Epub 2017 Feb 8.

Prognostic Impact of Physician Specialty on the Prognosis of Outpatients With Heart Failure: Propensity Matched Analysis of the REDINSCOR and RICA Registries.

[Article in English, Spanish]

Author information

1
Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain. Electronic address: jalvarezg@santpau.cat.
2
Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain.
3
Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
4
Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain.
5
Servicio de Epidemiología y Salud Pública, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
6
Servicio de Cardiología, Hospital Puerta del Mar, Cádiz, Spain.
7
Servicio de Medicina Interna, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
8
Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain.
9
Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain.
10
Servicio de Medicina Interna, Hospital Ramón y Cajal, Madrid, Spain.

Abstract

INTRODUCTION AND OBJECTIVES:

The specialty treating patients with heart failure (HF) has a prognostic impact in the hospital setting but this issue remains under debate in the ambulatory environment. We aimed to compare the clinical profile and outcomes of outpatients with HF treated by cardiologists or internists.

METHODS:

We analyzed the clinical, electrocardiogram, laboratory, and echocardiographic data of 2 prospective multicenter Spanish cohorts of outpatients with HF treated by cardiologists (REDINSCOR, n=2150) or by internists (RICA, n=1396). Propensity score matching analysis was used to test the influence of physician specialty on outcome.

RESULTS:

Cardiologist-treated patients were often men, were younger, and had ischemic etiology and reduced left ventricular ejection fraction (LVEF). Patients followed up by internists were predominantly women, were older, and a higher percentage had preserved LVEF and associated comorbidities. The 9-month mortality was lower in the REDINSCOR cohort (11.6% vs 16.9%; P<.001), but the 9-month HF-readmission rates were similar (15.7% vs 16.9%; P=.349). The propensity matching analysis selected 558 pairs of comparable patients and continued to show significantly lower 9-month mortality in the cardiology cohort (12.0% vs 18.8%; RR, 0.64; 95% confidence interval [95%CI], 0.48-0.85; P=.002), with no relevant differences in the 9-month HF-readmission rate (18.1% vs 17.2%; RR, 0.95; 95%CI, 0.74-1.22; P=.695).

CONCLUSIONS:

Age, sex, LVEF and comorbidities were major determinants of specialty-related referral in HF outpatients. An in-depth propensity matched analysis showed significantly lower 9-month mortality in the cardiologist cohort.

KEYWORDS:

Heart failure; Insuficiencia cardiaca; Prognosis; Pronóstico; Propensity score; Puntuación de propensión; Registro; Registry

Comment in

PMID:
28189543
DOI:
10.1016/j.rec.2016.12.026
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Ediciones Doyma, S.L.
Loading ...
Support Center