However, most patients do not receive this type of collaborative care.
Surprisingly, 1 in 5 patients did not visit any physician within one month of discharge despite the seriousness of the condition.
“Heart failure may not be taken seriously as a major problem particularly in those who are considered to be ‘safe’ to discharge home. However, our data suggest that they have poor outcomes and variable care,” says principal investigator and ICES Scientist Dr. Douglas Lee
The study of 10,599 patients who visited an ED for heart failure in Ontario between April 1, 2004 and March 31, 2007 found:
* 1 in 3 patients who visit an ED with heart failure symptoms are discharged home, and the care that they receive after discharge from the ED varies widely.
* Patients who were evaluated by both a cardiology specialist and a family physician within 30 days after ED discharge had the lowest rates of death, repeat ED visits or hospitalizations, compared to those who were seen by either type of MD alone.
* About 1 in 5 patients did not see any physician within 30 days of ED discharge despite the seriousness of heart failure.
* Patients who did not see any physician within 30 days after ED discharge for heart failure had the highest rates of death, repeat ED visits and hospitalizations.
Those who received care by both a cardiac specialist and a family doctor together were more likely to undergo important diagnostic tests and cardiac procedures, and demonstrated higher rates of drug therapies that have been shown to improve outcomes.
“Compared with patients who are admitted to hospital, heart failure patients who are discharged home from the emergency department are potentially more vulnerable because they have to navigate their own way through the health care system,” says Dr. Lee, a cardiologist at the Peter Munk Cardiac Centre, University Health Network. “Early follow-up with a medical team comprised of a cardiac specialist and a primary care provider was the optimal model of care in our study.”
Author affiliations: ICES (D.S. Lee, T.A. Stukel, P.C. Austin, D.A. Alter, M.J. Schull, J.J. You, A. Chong, D. Henry, J.V. Tu), Toronto General Hospital and University Health Network (D.S. Lee), Dalla Lana School of Public Health (T.A. Stukel, P.C. Austin, J.V. Tu), Sunnybrook Health Sciences Centre (M.J. Schull, J.V. Tu), Hamilton General Hospital, McMaster University (J.J. You), and University of Toronto (D.S. Lee, T.A. Stukel, P.C. Austin, D.A. Alter, M.J. Schull, A. Chong, D. Henry, J.V. Tu).
The study “Improved outcomes with early collaborative care of ambulatory heart failure patients discharged from the emergency department,” is published in the November 2, 2010, issue of Circulation.
More detailed study findings are available at www.ices.on.ca.
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