title: Consultation between specialists in Internal Medicine and Family Medicine improves management and prognosis of heart failure.
abstract: OBJECTIVE
  To evaluate if consultation between specialists in Internal Medicine and family doctors (CIMFD) improves the clinical management and prognosis of patients with heart failure (HF).
  
  
  METHODS
  
  
  
  METHODS
  prospective case-control study (5 years of follow-up).
  
  
  METHODS
  community-based sample within the area of a university teaching hospital.
  
  
  METHODS
  1857 patients (> or = 14 years) diagnosed for the first time with HF (1stDxHF), in the CIMFD.
  
  
  METHODS
  1981 patients (from health centres not covered by the CIMFD), 1stDxHF, in the external consultations of the hospital.
  
  
  METHODS
  mortality rate (MR). Admissions (HA). Emergency services visits (ESV). Delays in receiving specialist attention (DRSA), and the resolution of the process (DRP). Number (NTP) and delays in reporting (DTP) tests performed. Proportion (PRC) and delay (DRC) in resolving cases.
  
  
  RESULTS
  We observed a reduction of: MR (by 10.8%, CI 95%, 8.6-13.0, p < 0.005); HA, per patient per year (ppy) (by 1.8, 1.3-2.3, p < 0.01); ESV, ppy (by 1.9, 1.2-2.6, p < 0.01); DRSA (by 26.5 days, 21.8-31.2, p < 0.001); DRP (by 21.0 days, 18.3-23.7, p < 0.001), and DRC (by 25.8 days, 20.3-31.4, p < 0.01). The PRC (17.2%, CI 95%, 15.5-18.9, p < 0.01) was higher for the CIMFD.
  
  
  CONCLUSIONS
  The CIMFD approach improves prognosis and efficacy in the clinical management of patients with HF because it reduces mortality and morbidity (HA and ESV), shortens the delays in receiving care and in resolving the diagnostic and therapeutic process (DRSA, DRP, DRC), and increases the proportion of diagnosed and treated patients.
authors.affiliation: Department of Internal Medicine, University Hospital Puerto Real, University of Cádiz School of Medicine, Cadiz, Spain. francisco.gomez@uca.es
authors.forename: Francisco M
authors.initials: FM
authors.lastname: Gomez-Soto
authors.forename: José L
authors.initials: JL
authors.lastname: Puerto
authors.forename: José L
authors.initials: JL
authors.lastname: Andrey
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Fernandez
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Escobar
authors.forename: Antonio A
authors.initials: AA
authors.lastname: Garcia-Egido
authors.forename: Sotero P
authors.initials: SP
authors.lastname: Romero
authors.forename: José A
authors.initials: JA
authors.lastname: Bernal
authors.forename: F
authors.initials: F
authors.lastname: Gomez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management / Q000706:statistics & numerical data; D016022:Case-Control Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007388:Internal Medicine / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*