Specialist care gives better rate of survival

03/16/05

A better network of care and access involving specialists and family physicians is needed to save the lives of more heart patients, especially rural residents, according to a University of Alberta study.

"We need to find ways to improve timely and appropriate access to specialists and to improve the structuring of collaborative care," said Dr. Paul Armstrong, professor of medicine in the University of Alberta's division of cardiology, and one of the study's authors.

The researchers discovered that patients discharged after their first hospital stay for heart failure had significantly better outcomes if they received regular cardiovascular follow-up visits with a physician. Those who saw both a family practitioner and a specialist had the lowest mortality rates, even with more complicated conditions. Outpatient care involving both a specialist and a family physician was associated with a 66 per cent drop in the risk of one-year mortality.

"Unfortunately, we found that patients who were elderly and living in rural areas had less access to specialty care. We now know that only a minority of heart failure patients are seen in specialty heart failure clinics where it has been shown that outcomes are improved. These clinics tend to be located in specialty academic centres, which can be difficult for rural patients to access," said Dr. Armstrong.

Results from the two-year study, which also included research from the University of Ottawa, were published recently in the Canadian Medical Association Journal.

The population-based study followed 3,136 patients who were newly diagnosed with congestive heart failure and had just been discharged from 128 Alberta hospitals. Of the patients, 34 per cent received no follow-up visits for cardiovascular care, 24 per cent were seen by a family doctor alone, one per cent by a specialist and 42 per cent by both a family physician and a specialist.

The study showed that compared with patients who received no follow-up care, patients who received regular cardiovascular follow-ups with a specialist had 38 per cent fewer visits to the emergency room, only 13 per cent were readmitted to hospital and the one-year mortality rate was lower--22 per cent versus 37 per cent.

Patients who have follow-up care from both specialists and family physicians are in better health because they have more contacts with the medical community, Dr. Armstrong said. "There are more opportunities for deterioration in status to be detected, for medications to be altered, and for therapies to be reinforced.

Congestive heart failure is suffered by up to two per cent of North American adults, and despite advances in treatment and therapy, still holds a poor prognosis; 30 to 50 per cent die within a year.

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