According to this study, researchers determined that patients discharged from heart failure (HF) hospitalizations are more than 40% more likely to be rehospitalized within 30 days if they are admitted to hospitals' general medicine services than to their cardiology services. The study was published in the American Journal of Cardiology.
Also in the analysis, based on 900 patients hospitalized with HF, hospitalists caring for the 40% admitted to the general medicine service were more likely to omit important information from discharge summaries. And they were less likely to ensure patients were scheduled for a follow-up outpatient appointment with a cardiologist.
On the other hand, only 54% of patients in both the general medicine and cardiology services were scheduled for any kind of physician follow-up. To that end, the field should "figure out a way to empower hospitalists and provide them with the tools for taking care of this highly complicated patient population."
One approach within hospital systems might be to "expand the opportunities for hospitalists to learn about optimal strategies for treating heart failure patients." Processes that promote more thorough discharge summaries and better chances of scheduling appropriate follow-up appointments would help, Goyal said.
They think that involving hospitalists to help develop strategies to implement these processes on their services would be beneficial." The study looked at 926 patients with a median age of 73 years, discharged from an HF hospitalization at a major academic center in 2013 and 2014.
The cohort's unadjusted 30-day rate of readmission for any cause was 28% overall; it was 32% among those triaged to general medicine and 25% for those managed on the cardiology service. The odds ratio (OR) for 30-day readmission for the general-medicine vs cardiology cohorts was 1.43 (95% CI, 1.05 – 1.96; P = .02),
After adjustment for age, sex, third-party payer status, left ventricular ejection fraction (LVEF) less than 50% or 50% or greater, presence of right ventricular dysfunction, ventricular tachycardia (VT), admission systolic blood pressure, hospital length of stay, and whether a cardiology outpatient follow-up was scheduled.
Patients triaged to the general medicine service were more likely than those who went to the cardiology service to have HF with preserved ejection fraction (HFpEF); it followed, as well, that their mean LVEF was higher and they included more women.
However, "a lot of providers don't fully appreciate how sick a patient can be when their EF is greater than 50%." Prognosis is just as poor with HFpEF as with reduced-EF HF, he said, and it can be harder to treat because of a shortage of proven therapies and an often-greater comorbidity burden.
The comorbidity are the ones who are more likely going to the general medicine services. The rationale for that might be their abundance of comorbidities. But a secondary message from the study is that patients hospitalized with HFpEF generally need more attention from cardiologists and heart failure doctors.