Heart failure patients discharged from the ED are at lower risk for morbidity and mortality within 30 days if they receive early care by both a cardiologist and primary-care physician (PCP) than if seen by either physician alone, according to a recent analysis published in Circulation.
The ED is often the first point of contact for HF patients presenting to an acute care hospital, and while those patients who are admitted receive rapid medical care, non-hospitalized patients have varied experiences with care following discharge, both in timing and access to PCPs and specialists. While the importance of early follow-up for these patients is less controversial, there are conflicting opinions on the value of concurrent care by both a PCP and cardiologist, which the authors aimed to address.
The authors performed an analysis of all patients in Ontario, Canada who visited and were discharged from any ED for HF, examining the type of physician care received within 30 days post-discharge as well as outcomes during this time. Of the 10,599 patients included in the study, 62.2% received care only from a PCP, 5% only from a cardiologist, and 13.9% saw both a cardiologist and a PCP. Alarmingly, nearly a fifth of the patients in the study did not receive any physician follow-up, and were subsequently at the greatest risk of death and adverse events.
Patients who received collaborative care from both a PCP and cardiologist within 30 days had significantly lower rates of death, recurrent emergency visits, and hospitalization. In addition to better 30-day outcomes, early collaborative care was also associated with improved use of recommended drug therapies, interventions, and cardiovascular diagnostic tests than PCP care alone, which may lead to long-term improvement in outcomes. The authors note these results highlight both the benefits of collaborative care as well as the importance of rapid follow-up for HF patients discharged from the ED (Lee DS, et al., Circulation, 11/02).