Implementation of a Multidisciplinary Inpatient Cardiology Service to Improve Heart Failure Outcomes in Guyana
| Autor: | Robin Hao, Sheila L. Klassen, Nowell M. Fine, J. Wayne Warnica, Mahendra Carpen, Robert J.H. Miller, Debra Isaac |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Cardiology Developing country Disease 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Multidisciplinary approach Cause of Death Internal medicine Outcome Assessment Health Care Humans Medicine 030212 general & internal medicine Developing Countries Retrospective Studies Heart Failure Service (business) Inpatients business.industry Middle Aged medicine.disease Hospitalization Survival Rate Heart failure Public hospital Cohort Female Guideline Adherence Guyana Cardiology and Cardiovascular Medicine business Follow-Up Studies Cohort study |
| Zdroj: | Journal of Cardiac Failure. 24:835-841 |
| ISSN: | 1071-9164 |
| DOI: | 10.1016/j.cardfail.2018.07.002 |
| Popis: | Guyana is a small developing country with a high burden of cardiovascular disease and extensive barriers to optimal care delivery. We investigated the effectiveness of a newly established multidisciplinary inpatient cardiology service in this setting.We performed an interrupted time-series cohort study of heart failure (HF) patients admitted to the Georgetown Public Hospital Corporation from January to December 2015 and July 2016 to December 2017. The primary outcome was discharge on guideline-directed medical therapy (GDMT). Secondary outcomes included length of hospitalization and all-cause mortality.We identified 740 patients, 347 (46.9%) of whom were admitted after service implementation. The postimplementation cohort was more likely to be discharged on a beta-blocker (66.6% vs 41.7%; P.01) and mineralocorticoid receptor antagonist (31.7% vs 15.3%; P = .01). They were also more likely to undergo echocardiography (60.8% vs 40.5%; P.01) and chest x-rays (70.6% vs 46.6%; P.01). Hospitalization length (10.0 ± 13.1 vs 9.8 ± 10.1 days) and readmissions within 90 days (19.0% vs 19.1%) were not significantly different. There were fewer deaths in the postimplementation cohort compared with the preimplementation cohort (12/347 vs 28/393).Establishment of a multidisciplinary inpatient cardiology service demonstrated increased adherence to GDMT without extending length of hospitalization. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect