title: Outcomes of patients with acute decompensated heart failure managed by cardiologists versus noncardiologists.
abstract: Physician practice patterns in the management of hospitalized acute decompensated heart failure (ADHF) patients may vary by specialty; comparative practice patterns in ADHF management and clinical outcomes as a function of provider type have not been well reported. We studied a total of 496 patients discharged with the principal diagnosis of ADHF to analyze practice patterns among 3 provider types (cardiologists, hospitalists, and nonhospitalists). We examined outcomes of death and rehospitalization for HF and adherence to the Joint Commission HF performance core measures. Cardiologists had the highest adherence in all 4 HF core measures compared with hospitalists and nonhospitalists. At 6 months, 6.0% of the patients cared by cardiologists died compared with 10.9% and 11.4% cared by hospitalist and nonhospitalists (p = 0.12). Patients cared for by cardiologists had a significantly lower 6-month ADHF readmission rate (16.2%) compared with hospitalists (40.1%) and nonhospitalists (34.9%, p <0.001). In multivariate analysis, both hospitalist and nonhospitalist provider types were an independent predictor for 6-month ADHF-related readmission (hospitalists vs cardiologists, hazard ratioadjusted 3.01; 95% confidence interval 1.84 to 4.89, p <0.001; and nonhospitalists vs cardiologists, hazard ratioadjusted 2.07; 95% confidence interval 1.24 to 3.46, p = 0.005). In conclusion, cardiologist-delivered ADHF care is associated with greater adherence to HF core measures and with significantly lower rates of adverse outcome compared with noncardiologists.
authors: Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts.
authors: Shanmugam
authors: S
authors: Uthamalingam
authors: Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, Arizona.
authors: Jagdesh
authors: J
authors: Kandala
authors: Department of Internal Medicine, Baystate Medical Center, Springfield, Massachusetts. Electronic address: vijairam.selvaraj@bhs.org.
authors: Vijairam
authors: V
authors: Selvaraj
authors: Hospitalist Division, Dartmouth Hitchcock Clinic at Catholic Medical Center, Manchester, New Hampshire.
authors: William
authors: W
authors: Martin
authors: Division of Cardiology, New England Heart Institute, Catholic Medical Center, Manchester, New Hampshire.
authors: Marlyn
authors: M
authors: Daley
authors: Division of Cardiology, St Elizabeth Medical Center, Boston, Massachusetts.
authors: Eshan
authors: E
authors: Patvardhan
authors: Division of Cardiology, New England Heart Institute, Catholic Medical Center, Manchester, New Hampshire.
authors: Robert
authors: R
authors: Capodilupo
authors: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors: Stephanie
authors: S
authors: Moore
authors: Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts.
authors: James L
authors: JL
authors: Januzzi
mesh_terms: D000208:Acute Disease; D000368:Aged; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy*; D020445:Hospitalists / Q000592:standards*; D006801:Humans; D008297:Male; D010820:Physicians / Q000592:standards*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D016896:Treatment Outcome