Abstract 12563: Variation in Referral for Specialist Follow-Up and 30-Day Mortality in Patients Hospitalized With Heart Failure in England and Wales
| Autor: | Kazem Rahimi, Connor A Emdin, John G Cleland, Henry Dargie, Reza Korshidi, Suzanna Hardman, Mark Woodward, Stephen MacMahon, Polly Mitchell, Theresa McDonagh |
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| Rok vydání: | 2014 |
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| Zdroj: | Circulation. 130 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/circ.130.suppl_2.12563 |
| Popis: | Introduction: Current US and European guidelines recommend that patients hospitalized with heart failure (HF) are followed up after discharge, but do not specify whether or not this should be with HF specialist services. We investigated referral patterns to specialist services amongst hospitals in England and Wales and assessed whether these differences were associated with 30-day mortality. Methods: We used data from the National Heart Failure Audit, which included 84647 HF patients from 176 hospitals. Vital status was obtained from the UK national death registry. Using hierarchical statistical models and instrumental variable analysis, we estimated whether different types of follow-up (cardiologist, HF nurse or geriatrician) were associated with 30-day mortality, adjusting for case mix. Results: At the hospital level, rates of referral to cardiologists for follow up varied from 4% to 94%, to HF nurses from 0% to 97% and to geriatricians from 0% to 65%. When heart failure patients were referred for follow-up to a heart failure nurse, to a geriatrician, or to a cardiologist, they were 15%, 15% and 47% less likely to die than patients who were not referred to these specialists (odds ratio [OR] = 0.85, p Conclusion: Referral at discharge to cardiology services for follow-up varies considerably amongst UK hospitals. At both an individual patient and at a hospital level, referral to cardiology for follow-up is a major determinant of 30-day mortality. |
| Databáze: | OpenAIRE |
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