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Congestive Heart Failure


NORTHBROOK, IL -- August 13, 1999 -- Hospitalized congestive heart failure (CHF) patients treated by cardiologists are less likely to be readmitted to the hospital and more likely to have a better quality-of-life than those treated by other physicians, according to a new study. Investigators from Henry Ford Hospital in Detroit and the Mary Imogene Bassett Research Institute in Cooperstown, New York, reported their findings today in the August issue of CHEST,the peer-reviewed journal of the American College of Chest Physicians (ACCP). Heart failure, most common in the elderly, is a serious, often fatal condition, in which the heart is unable to pump enough blood to supply the body's needs. It usually develops gradually as a result of previous conditions like a heart attack or chronic high blood pressure. Diuretics and digitalis have long been the most common drugs used to help control the symptoms of heart failure. Within the past decade, however, major clinical trials have shown that ACE (angiotensin-converting enzyme) inhibitors can help patients with heart failure lead longer, more active lives.

They also help the heart function more effectively by easing the load on the failing heart by relaxing and expanding blood vessels and by getting rid of excess salt and water. Authors of the study contended that many of the new treatment modalities for CHF require the expertise of highly trained specialty physicians. At the same time, they noted, managed care plans are placing increasing emphasis on the role of the primary care physician in the treatment of CHF. While noting that differences between cardiologists and noncardiologists in treating several cardiovascular diseases have been reported in the past, they said they were unaware of any studies dealing with the treatment of CHF in a community hospital setting.

The study involved 2,454 patients at 10 community hospitals who were placed in one of three groups: patients not treated by a cardiologist; patients whose attending physician was a cardiologist; and patients who had consultation from a cardiologist but whose attending physician of record was not a cardiologist. All of the patients were measured in four clinical outcome areas: length of hospital stay; mortality; readmission to the hospital; and quality of life. Patients who survived their hospital stay were followed for six months.

In addition to clinical outcomes, investigators also analyzed the types of treatment given to patients. For example, those patients treated by a cardiologist or for whom consultation by a cardiologist was given were much more likely to have the cause of their CHF documented in their charts. They were also more likely to undergo echocardiograms or radionuclide ventriculograms, and they were more likely to receive dietary counseling and case management strategies. These patients were also more likely to have ACE inhibitors prescribed.

Lead author, Edward F. Philbin, M.D., said when compared to treatment by noncardiologists, direct care provided by attending physicians who were cardiologists was associated with lower risk of readmission for CHF and a better quality-of-life measure. However, hospital charges were higher, and there was little difference in mortality rates and length of hospital stays. "Inasmuch as half of all CHF patients receive their care in non-teaching hospitals, the implications of this study are not trivial," Dr. Philbin said. "It is not known whether a more rigorous compliance with published guidelines by noncardiologists would offer the same benefits as cardiology specialty care. In our opinion, the relationship between physician specialty, process of care, and clinical outcomes requires further study before effective sweeping health manpower recommendations can be made."