title: In-hospital cardiology consultation and evidence-based care for nursing home residents with heart failure.
abstract: OBJECTIVE
  To determine the association between cardiology consultation and evidence-based care for nursing home (NH) residents with heart failure (HF).
  
  
  METHODS
  Hospitalized NH residents (n = 646) discharged from 106 Alabama hospitals with a primary discharge diagnosis of HF during 1998-2001.
  
  
  METHODS
  Observational. MEASUREMENTS OF EVIDENCE-BASED CARE: Preadmission estimation of left ventricular ejection fraction (LVEF) for patients with known HF (n = 494), in-hospital LVEF estimation for HF patients without known LVEF (n = 452), and discharge prescriptions of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs or ARBs) to systolic HF (LVEF <45%) patients discharged alive who were eligible to receive those drugs (n = 83). Eligibility for ACEIs or ARBs was defined as lack of prior allergy or adverse effect, serum creatinine lower than 2.5 mg/dL, serum potassium lower than 5.5 mEq/L, and systolic blood pressure higher than 100 mm Hg.
  
  
  RESULTS
  Preadmission LVEF was estimated in 38% and 12% of patients receiving and not receiving cardiology consultation, respectively (adjusted odds ratio [AOR], 3.49; 95% CI, 2.16-5.66; P < .001). In-hospital LVEF was estimated in 71% and 28% of patients receiving and not receiving cardiology consultation, respectively (AOR, 6.01; 95% CI, 3.69-9.79; P < .001). ACEIs or ARBs were prescribed to 62% and 82% of patients receiving and not receiving cardiology consultation, respectively (AOR, 0.24; 95% CI, 0.07-0.81; P = .022).
  
  
  CONCLUSIONS
  In-hospital cardiology consultation was associated with significantly higher odds of LVEF estimation among NH residents with HF; however, it did not translate into higher odds of discharge prescriptions for ACEIs or ARBs to NH residents with systolic HF who were eligible for the receipt of these drugs.
authors: New York Medical College, Valhalla, NY, USA.
authors: Wilbert S
authors: WS
authors: Aronow
authors: Michael W
authors: MW
authors: Rich
authors: Sarah J
authors: SJ
authors: Goodlin
authors: Thomas
authors: T
authors: Birkner
authors: Yan
authors: Y
authors: Zhang
authors: Margaret A
authors: MA
authors: Feller
authors: Inmaculada B
authors: IB
authors: Aban
authors: Linda G
authors: LG
authors: Jones
authors: Donna M
authors: DM
authors: Bearden
authors: Richard M
authors: RM
authors: Allman
authors: Ali
authors: A
authors: Ahmed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000407:Alabama; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002309:Cardiology; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D008297:Male; D009735:Nursing Homes; D012017:Referral and Consultation; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors