Heart failure patients better off if they see their family doctor and a specialist

New research done at the Institute for Clinical Evaluative Sciences (ICES) has found that patients with heart failure who received care by both a cardiac specialist and a family physician within the first 30 days after their Emergency Department (ED) visit were least likely to die or be hospitalized. However, most patients do not receive this type of collaborative care.

Surprisingly, 1 in 5 patients did not visit any physician within one month of discharge despite the seriousness of the condition.

“Heart failure may not be taken seriously as a major problem particularly in those who are considered to be 'safe' to discharge home. However, our data suggest that they have poor outcomes and variable care,” says principal investigator and ICES scientist Dr. Douglas Lee.

The study of 10,599 patients who visited an ED for heart failure in Ontario between April 1, 2004 and March 31, 2007 found:

• 1 in 3 patients who visit an ED with heart failure symptoms are discharged home, and the care that they receive after discharge from the ED varies widely.
• Patients who were evaluated by both a cardiology specialist and a family physician within 30 days after ED discharge had the lowest rates of death, repeat ED visits or hospitalizations, compared to those who were seen by either type of MD alone.
• About 1 in 5 patients did not see any physician within 30 days of ED discharge despite the seriousness of heart failure.
• Patients who did not see any physician within 30 days after ED discharge for heart failure had the highest rates of death, repeat ED visits and hospitalizations.
• Those who received care by both a cardiac specialist and a family doctor together were more likely to undergo important diagnostic tests and cardiac procedures, and demonstrated higher rates of drug therapies that have been shown to improve outcomes.

“Compared with patients who are admitted to hospital, heart failure patients who are discharged home from the emergency department are potentially more vulnerable because they have to navigate their own way through the healthcare system,” says Dr. Lee, a cardiologist at the Peter Munk Cardiac Centre, University Health Network. “Early follow-up with a medical team comprised of a cardiac specialist and a primary care provider was the optimal model of care in our study.”

Author affiliations: ICES (D.S. Lee, T.A. Stukel, P.C. Austin, D.A. Alter, M.J. Schull, J.J. You, A. Chong, D. Henry, J.V. Tu), Toronto General Hospital and University Health Network (D.S. Lee), Dalla Lana School of Public Health (T.A. Stukel, P.C. Austin, J.V. Tu), Sunnybrook Health Sciences Centre (M.J. Schull, J.V. Tu), Hamilton General Hospital, McMaster University (J.J. You), and University of Toronto (D.S. Lee, T.A. Stukel, P.C. Austin, D.A. Alter, M.J. Schull, A. Chong, D. Henry, J.V. Tu).

The study “Improved outcomes with early collaborative care of ambulatory heart failure patients discharged from the emergency department,” is published in the November 2, 2010, issue of Circulation.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

For further information, please contact:

• Deborah Creatura
• Media Advisor, ICES
• [email protected]
• 416-480-4780 or cell 647-406-5996