title: Prognostic Impact of Physician Specialty on the Prognosis of Outpatients With Heart Failure: Propensity Matched Analysis of the REDINSCOR and RICA Registries.
abstract: OBJECTIVE
  The specialty treating patients with heart failure (HF) has a prognostic impact in the hospital setting but this issue remains under debate in the ambulatory environment. We aimed to compare the clinical profile and outcomes of outpatients with HF treated by cardiologists or internists.
  
  
  METHODS
  We analyzed the clinical, electrocardiogram, laboratory, and echocardiographic data of 2 prospective multicenter Spanish cohorts of outpatients with HF treated by cardiologists (REDINSCOR, n=2150) or by internists (RICA, n=1396). Propensity score matching analysis was used to test the influence of physician specialty on outcome.
  
  
  RESULTS
  Cardiologist-treated patients were often men, were younger, and had ischemic etiology and reduced left ventricular ejection fraction (LVEF). Patients followed up by internists were predominantly women, were older, and a higher percentage had preserved LVEF and associated comorbidities. The 9-month mortality was lower in the REDINSCOR cohort (11.6% vs 16.9%; P<.001), but the 9-month HF-readmission rates were similar (15.7% vs 16.9%; P=.349). The propensity matching analysis selected 558 pairs of comparable patients and continued to show significantly lower 9-month mortality in the cardiology cohort (12.0% vs 18.8%; RR, 0.64; 95% confidence interval [95%CI], 0.48-0.85; P=.002), with no relevant differences in the 9-month HF-readmission rate (18.1% vs 17.2%; RR, 0.95; 95%CI, 0.74-1.22; P=.695).
  
  
  CONCLUSIONS
  Age, sex, LVEF and comorbidities were major determinants of specialty-related referral in HF outpatients. An in-depth propensity matched analysis showed significantly lower 9-month mortality in the cardiologist cohort.
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain. Electronic address: jalvarezg@santpau.cat.
authors.forename: Jesús
authors.initials: J
authors.lastname: Álvarez-García
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Prado
authors.initials: P
authors.lastname: Salamanca-Bautista
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Andreu
authors.initials: A
authors.lastname: Ferrero-Gregori
authors.affiliation: Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Montero-Pérez-Barquero
authors.affiliation: Servicio de Epidemiología y Salud Pública, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Puig
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Aramburu-Bodas
authors.affiliation: Servicio de Cardiología, Hospital Puerta del Mar, Cádiz, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Vázquez
authors.affiliation: Servicio de Medicina Interna, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Arias-Jiménez
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Vives-Borrás
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: J Manuel
authors.initials: JM
authors.lastname: Cerqueiro González
authors.affiliation: Servicio de Medicina Interna, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Cinca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002309:Cardiology; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D057216:Propensity Score; D012017:Referral and Consultation; D012042:Registries; D013030:Spain
keywords: Heart failure; Insuficiencia cardiaca; Prognosis; Pronóstico; Propensity score; Puntuación de propensión; Registro; Registry