Comanagement of patients with congestive heart failure by family physicians and cardiologists - Frequency, timing, and patient characteristics

BACKGROUND. Many patients with congestive heart failure (CHF) receive care solely from a primary care physician, while some receive care from both a p rimary care physician and a cardiologist. Patients in the latter type of ca re relationships have not been described. The principal objectives of our s tudy were to determine what percentage of patients with CHF are comanaged, the characteristics of comanaged CHF patients, and when in the natural hist ory of CHF this relationship is initiated. METHODS. A retrospective record review was conducted of all patients who me t the modified Framingham criteria for the diagnosis of CHF in a large comm unity-based family practice office. Comanagement was defined as an ongoing relationship with a cardiologist characterized by a minimum of one visit to the cardiologist's office in the year of evaluation. We divided the natura l history of CHF into 4 stages to describe the timing of the initial referr al to the cardiologist: I Prediagnosis; II Diagnosis; III Progression; and IV Terminal. RESULTS. Of 151 patients identified with CHF, 36% of the patients were coma naged by a primary care physician and a cardiologist. The comanagement rela tionship often began early in the development of CHF, 20% at stage I and 54 % at stage II. The patients who were comanaged were younger, predominately men, had a greater frequency of myocardial infarction, were more likely to have decreased systolic function, were on more cardiac medications, and had fewer hospitalizations for CHF exacerbations compared with CHF patients ma naged solely by family physicians. CONCLUSIONS. Comanagement of patients with CHFs a common occurrence, and co managed CHF patients have distinct characteristics from those managed solel y by family physicians. These results have implications for the quality and cost of caring for patients with CHF and suggest that more detailed study is required.