title: Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations.
abstract: OBJECTIVE
  Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations.
  
  
  METHODS
  We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected.
  
  
  RESULTS
  Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99).
  
  
  CONCLUSIONS
  Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: André C
authors.initials: AC
authors.lastname: Marques
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Daniela
authors.initials: D
authors.lastname: Calderaro
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Pai C
authors.initials: PC
authors.lastname: Yu
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Gualandro
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Gabriel A L
authors.initials: GA
authors.lastname: Carmo
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Fernanda R
authors.initials: FR
authors.lastname: Azevedo
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Adriana F
authors.initials: AF
authors.lastname: Pastana
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Eneas M O
authors.initials: EM
authors.lastname: Lima
authors.affiliation: Centro de Cardiologia, Hospital Sírio Libanês, São Paulo, SP, Brazil.
authors.forename: Maristela
authors.initials: M
authors.lastname: Monachini
authors.affiliation: Unidade de Medicina Interdisciplinar em Cardiologia, Instituto do Coração (INCOR) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Caramelli
mesh_terms: D000367:Age Factors; D000368:Aged; D002309:Cardiology / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome