TREATMENT OF PATIENTS ADMITTED TO THE HOSPITAL WITH CONGESTIVE-HEART-FAILURE - SPECIALTY-RELATED DISPARITIES IN PRACTICE PATTERNS AND OUTCOMES

Objectives. This study sought to define specialty-related differ ences in the care and outcome of patients admitted to the hospital with con gestive heart failure (CHP). Background. Congestive heart failure is t he leading diagnosis-related group (DRG) discharge diagnosis in the Un ited States and accounts for an estimated annual hospital cost in exce ss of $7 billion. The clinical impact of aggressive CHF management and the importance of the subspecialist in guiding this care have not bee n evaluated. Methods. To define differences in physician practice patt erns, we performed a chart review of consecutive patients admitted to a university teaching hospital with a primary DRG discharge diagnosis of CHF. We compared treatment and outcome of patients cared for by a g eneralist (n = 160) and those whose care was guided by a cardiologist (n = 138) during their index hospital period,vith CHF and over the nex t 6 months. Results. At our institution, >50% of patients admitted to the hospital with CHF cared for by generalists alone had minimal (New York Heart Association functional class I or II) symptoms, compared wi th <15% of those cared for by a cardiologist (p < 0.01). Although gene ralists' patients underwent significantly fewer in hospital diagnostic tests and had shorter lengths of stay, they had a 1.7-fold increased risk of readmission for CHF within 6 months (p < 0.05). Six month card iac and all-cause mortality were not significantly different between t he groups. The type of physician caring for the patient and a history of diabetes, previous CHF or myocardial infarction were independent pr edictors of readmission for CHF. Conclusions. Involvement of a cardiol ogist in the care of patients admitted to the hospital with CHF is ass ociated with increased use of diagnostic testing, longer hospital stay s and improved clinical outcome. These results substantiate practice g uidelines that suggest a role for cardiologists in the care of symptom atic patients with CHF. (C) 1997 by the American College of Cardiology .