학술논문
The prognostic impact of specialist cardiology input in patients admitted for heart failure and normal ejection fraction.
Document Type
Academic Journal
Author
Cannata A; Department of Cardiology, King's College Hospital London, London, UK.; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.; Badawy L; Department of Cardiology, King's College Hospital London, London, UK.; Anyu AT; Department of Cardiology, King's College Hospital London, London, UK.; Samways J; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.; Sweeney M; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.; Jordan-Rios A; Department of Cardiology, King's College Hospital London, London, UK.; Zakeri R; Department of Cardiology, King's College Hospital London, London, UK.; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.; Scott PA; Department of Cardiology, King's College Hospital London, London, UK.; Piper S; Department of Cardiology, King's College Hospital London, London, UK.; Plymen CM; Department of Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.; McDonagh TA; Department of Cardiology, King's College Hospital London, London, UK.; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.; Bromage DI; Department of Cardiology, King's College Hospital London, London, UK.; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.
Source
Publisher: John Wiley & Sons Ltd on behalf of the European Society of Cardiology Country of Publication: England NLM ID: 101669191 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2055-5822 (Electronic) Linking ISSN: 20555822 NLM ISO Abbreviation: ESC Heart Fail Subsets: MEDLINE
Subject
Language
English
Abstract
Aims: Specialist cardiology care is associated with a prognostic benefit in patients with heart failure (HF) with reduced ejection fraction (HFrEF) admitted with decompensated HF. However, up to one third of patients admitted with HF and normal ejection fraction (HFnEF) do not receive specialist cardiology input. Whether this has prognostic implications is unknown.
Methods and Results: Data on patients hospitalized with HFnEF from two tertiary centres were analysed. The primary outcome measure was all-cause mortality during follow-up. The secondary outcome was in-hospital mortality. A total of 1413 patients were included in the study. Of these, 23% (n = 322) did not receive in-hospital specialist cardiology input. Patients seen by a cardiologist were less likely to have hypertension (73% vs. 79%, P = 0.03) and respiratory co-morbidities (25% vs. 31%, P = 0.02) compared with those who did not receive specialist input. Similarly, clinical presentation was more severe for those who received specialist input (New York Heart Association III/IV 83% vs. 75% respectively, P = 0.003; moderate-to-severe peripheral oedema 65% vs. 54%, P < 0.001). Medical management was similar, except for a higher use of diuretics (90% vs. 86%, P = 0.04) and a longer length of stay for patients who received specialist input (9 vs. 4 days, P < 0.001). Long-term outcomes were comparable between patients who received specialist input and those who did not. However, specialist input was independently associated with lower in-hospital mortality (hazard ratio 0.19, confidence interval 0.09-0.43, P < 0.001).
Conclusions: In-hospital cardiology specialist input has no long-term prognostic advantage in patients with HFnEF but is independently associated with reduced in-hospital mortality.
(© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)
Methods and Results: Data on patients hospitalized with HFnEF from two tertiary centres were analysed. The primary outcome measure was all-cause mortality during follow-up. The secondary outcome was in-hospital mortality. A total of 1413 patients were included in the study. Of these, 23% (n = 322) did not receive in-hospital specialist cardiology input. Patients seen by a cardiologist were less likely to have hypertension (73% vs. 79%, P = 0.03) and respiratory co-morbidities (25% vs. 31%, P = 0.02) compared with those who did not receive specialist input. Similarly, clinical presentation was more severe for those who received specialist input (New York Heart Association III/IV 83% vs. 75% respectively, P = 0.003; moderate-to-severe peripheral oedema 65% vs. 54%, P < 0.001). Medical management was similar, except for a higher use of diuretics (90% vs. 86%, P = 0.04) and a longer length of stay for patients who received specialist input (9 vs. 4 days, P < 0.001). Long-term outcomes were comparable between patients who received specialist input and those who did not. However, specialist input was independently associated with lower in-hospital mortality (hazard ratio 0.19, confidence interval 0.09-0.43, P < 0.001).
Conclusions: In-hospital cardiology specialist input has no long-term prognostic advantage in patients with HFnEF but is independently associated with reduced in-hospital mortality.
(© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)