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Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2017;70:347-54 - Vol. 70 Num.05 DOI: 10.1016/j.rec.2016.12.026

Prognostic Impact of Physician Specialty on the Prognosis of Outpatients With Heart Failure: Propensity Matched Analysis of the REDINSCOR and RICA Registries

Jesús Álvarez-García a,, Prado Salamanca-Bautista b, Andreu Ferrero-Gregori a, Manuel Montero-Pérez-Barquero c, Teresa Puig d, Óscar Aramburu-Bodas b, Rafael Vázquez e, Francesc Formiga f, Juan Delgado g, José Luis Arias-Jiménez b, Miquel Vives-Borrás a, J. Manuel Cerqueiro González h, Luis Manzano i, Juan Cinca a

a Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
b Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain
c Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain
d Servicio de Epidemiología y Salud Pública, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
e Servicio de Cardiología, Hospital Puerta del Mar, Cádiz, Spain
f Servicio de Medicina Interna, IDIBELL, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
g Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
h Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain
i Servicio de Medicina Interna, Hospital Ramón y Cajal, Madrid, Spain

Refers to

About the Specialty Treating Patients With Heart Failure
Joan Carles Trullàs, Òscar Miró
Rev Esp Cardiol. 2017;70:611
Full text - PDF

Keywords

Heart failure. Registry. Prognosis. Propensity score.

Abstract

Introduction and objectives

The specialty treating patients with heart failure (HF) has a prognostic impact in the hospital setting but this issue remains under debate in the ambulatory environment. We aimed to compare the clinical profile and outcomes of outpatients with HF treated by cardiologists or internists.

Methods

We analyzed the clinical, electrocardiogram, laboratory, and echocardiographic data of 2 prospective multicenter Spanish cohorts of outpatients with HF treated by cardiologists (REDINSCOR, n = 2150) or by internists (RICA, n = 1396). Propensity score matching analysis was used to test the influence of physician specialty on outcome.

Results

Cardiologist-treated patients were often men, were younger, and had ischemic etiology and reduced left ventricular ejection fraction (LVEF). Patients followed up by internists were predominantly women, were older, and a higher percentage had preserved LVEF and associated comorbidities. The 9-month mortality was lower in the REDINSCOR cohort (11.6% vs 16.9%; P < .001), but the 9-month HF-readmission rates were similar (15.7% vs 16.9%; P = .349). The propensity matching analysis selected 558 pairs of comparable patients and continued to show significantly lower 9-month mortality in the cardiology cohort (12.0% vs 18.8%; RR, 0.64; 95% confidence interval [95%CI], 0.48-0.85; P = .002), with no relevant differences in the 9-month HF-readmission rate (18.1% vs 17.2%; RR, 0.95; 95%CI, 0.74-1.22; P = .695).

Conclusions

Age, sex, LVEF and comorbidities were major determinants of specialty-related referral in HF outpatients. An in-depth propensity matched analysis showed significantly lower 9-month mortality in the cardiologist cohort.

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1885-5857/© 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved