TY - JOUR
T1 - Prognostic Impact of Physician Specialty on the Prognosis of Outpatients With Heart Failure: Propensity Matched Analysis of the REDINSCOR and RICA Registries
AU - Álvarez-García, Jesús
AU - Salamanca-Bautista, Prado
AU - Ferrero-Gregori, Andreu
AU - Montero-Pérez-Barquero, Manuel
AU - Puig, Teresa
AU - Aramburu-Bodas, Óscar
AU - Vázquez, Rafael
AU - Formiga, Francesc
AU - Delgado, Juan
AU - Arias-Jiménez, José Luis
AU - Vives-Borrás, Miquel
AU - Cerqueiro González, J. Manuel
AU - Manzano, Luis
AU - Cinca, Juan
PY - 2017/5/1
Y1 - 2017/5/1
N2 - © 2016 Sociedad Española de Cardiología Introduction and objectives 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. Full English text available from: www.revespcardiol.org/en
AB - © 2016 Sociedad Española de Cardiología Introduction and objectives 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. Full English text available from: www.revespcardiol.org/en
KW - Heart failure
KW - Prognosis
KW - Propensity score
KW - Registry
U2 - 10.1016/j.recesp.2016.09.021
DO - 10.1016/j.recesp.2016.09.021
M3 - Article
VL - 70
SP - 347
EP - 354
IS - 5
ER -