Skip to main content
Journal cover image

Is specialty care associated with improved survival of patients with congestive heart failure?

Publication ,  Journal Article
Indridason, OS; Coffman, CJ; Oddone, EZ
Published in: Am Heart J
February 2003

BACKGROUND: Implementation of the complex treatment strategies that have been shown to improve survival of patients with congestive heart failure (CHF) may require certain expertise. We wanted to examine the association between pattern of outpatient care and survival of patients with CHF. METHODS: In a retrospective cohort study conducted with national Veterans Health Administration (VHA) databases, we examined the association between the pattern of outpatient care and survival in 11,661 patients discharged from VA hospitals between October 1, 1991, and September 30, 1992, with the primary diagnosis of CHF (cohort 1). Patients were divided into 4 groups, on the basis of their pattern of outpatient care over a 12-month period after discharge: 1) general medicine clinic visits only (GM-only); 2) cardiology clinic visits only (CARD-only); 3) general medicine and cardiology (MIXED) clinic visits; and 4) neither general medicine nor cardiology clinic visits (no-GM/CARD). We used the Cox proportional hazards model to evaluate 1-year survival, controlling for clinical and demographic factors. Consistency of our results was examined by performing identical analysis on a cohort of patients discharged from VHA hospitals between October 1, 1994, and September 30, 1995 (cohort 2, n = 10,141). RESULTS: The overall 1-year mortality rate was 23% in the primary cohort. The unadjusted mortality rate was highest for patients in the no-GM/CARD follow up (29%) and lowest for patients in the MIXED group (19%). By use of the MIXED group as reference and adjusting for important clinical and demographic factors, the risk of death (risk ratio [95% CI]) was 1.12 (0.94-1.34) in the CARD-only group, 1.26 (1.15-1.38) in the GM-only group, and 1.48 (1.28-1.72) in the no-GM/CARD group. Cohort-2 results were consistent with cohort 1 for most covariates, and significant survival differences were again found between GM-only and the MIXED group (1.25 [1.14-1.37]). CONCLUSIONS: We found an improved survival associated with cardiologist care and a mixture of general practitioner and cardiologist care compared with general practitioner care. The pattern of outpatient care may therefore be important for the survival of patients with CHF.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2003

Volume

145

Issue

2

Start / End Page

300 / 309

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • Proportional Hazards Models
  • Prognosis
  • Patient Discharge
  • Outpatient Clinics, Hospital
  • Outcome Assessment, Health Care
  • Male
  • Humans
  • Hospitals, Veterans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Indridason, O. S., Coffman, C. J., & Oddone, E. Z. (2003). Is specialty care associated with improved survival of patients with congestive heart failure? Am Heart J, 145(2), 300–309. https://doi.org/10.1067/mhj.2003.54
Indridason, Olafur S., Cynthia J. Coffman, and Eugene Z. Oddone. “Is specialty care associated with improved survival of patients with congestive heart failure?Am Heart J 145, no. 2 (February 2003): 300–309. https://doi.org/10.1067/mhj.2003.54.
Indridason OS, Coffman CJ, Oddone EZ. Is specialty care associated with improved survival of patients with congestive heart failure? Am Heart J. 2003 Feb;145(2):300–9.
Indridason, Olafur S., et al. “Is specialty care associated with improved survival of patients with congestive heart failure?Am Heart J, vol. 145, no. 2, Feb. 2003, pp. 300–09. Pubmed, doi:10.1067/mhj.2003.54.
Indridason OS, Coffman CJ, Oddone EZ. Is specialty care associated with improved survival of patients with congestive heart failure? Am Heart J. 2003 Feb;145(2):300–309.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

February 2003

Volume

145

Issue

2

Start / End Page

300 / 309

Location

United States

Related Subject Headings

  • United States
  • Survival Rate
  • Proportional Hazards Models
  • Prognosis
  • Patient Discharge
  • Outpatient Clinics, Hospital
  • Outcome Assessment, Health Care
  • Male
  • Humans
  • Hospitals, Veterans