Impact of cardiology referral: clinical outcomes and factors associated with physicians' adherence to recommendations

Abstract

OBJECTIVES:Cardiology referral is common for patients admitted for non-cardiac diseases. Recommendations from cardiologists may involve complex and aggressive treatments that could be ignored or denied by other physicians. The purpose of this study was to compare the outcomes of patients who were given recommendations during cardiology referrals and to examine the clinical outcomes of patients who did not follow the recommendations.METHODS:We enrolled 589 consecutive patients who received in-hospital cardiology consultations. Data on recommendations, implementation of suggestions and outcomes were collected.RESULTS:Regarding adherence of the referring service to the recommendations, 77% of patients were classified in the adherence group and 23% were classified in the non-adherence group. Membership in the non-adherence group (p<0.001; odds ratio: 10.25; 95% CI: 4.45-23.62) and advanced age (p = 0.017; OR: 1.04; 95% CI: 1.01-1.07) were associated with unfavorable outcomes. Multivariate analysis identified four independent predictors of adherence to recommendations: follow-up notes in the medical chart (p<0.001; OR: 2.43; 95% CI: 1.48-4.01); verbal reinforcement (p = 0.001; OR: 1.86; 95% CI: 1.23-2.81); a small number of recommendation (p = 0.001; OR: 0.87; 95% CI: 0.80-0.94); and a younger patient age (p = 0.002; OR: 0.98; 95% CI: 0.96-0.99).CONCLUSIONS:Poor adherence to cardiology referral recommendations was associated with unfavorable clinical outcomes. Follow-up notes in the medical chart, verbal reinforcement, a limited number of recommendations and a patient age were associated with greater adherence to recommendations.

3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY

“…During this period, diagnosis of previously unknown diseases, which can be optimized for a better perioperative evolution and, more importantly, for a better long-term prognosis, is often possible. 55 …”

Characteristics of Disease Profile of Hospitalized Patients Referred to the Department of Cardiology in a Tertiary Care Hospital

“…Taking cardiology consultation from a non-cardiac case is common in every hospital. 8 This is because of not only for excluding any cardiac diseases but also to make sure that no serious cardiac disease of atypical presentation is missed which can be fatal for the patients. [2][3][4]9 We conducted this cross sectional study with the main purpose of making a disease profile of the patients.…”

“…This is also the same cause of referral to the cardiology unit in abroad. 8 As a universal rule, the frequency of taking cardiology consultation before going for surgery (esp under GA) is much higher than from other medical speciality. 8 This is why, in our study also reflects this pattern of referral.…”

“…8 As a universal rule, the frequency of taking cardiology consultation before going for surgery (esp under GA) is much higher than from other medical speciality. 8 This is why, in our study also reflects this pattern of referral. Interpreting ECG is an interesting cause of referral, because all of these patients were completely asymptomatic and their ECG findings were also normal.…”

Perioperative cardiology: an inspiring arena for theChameleon doctor

“…For example, it could be challenging to convince the team that aspirin must be maintained in a previously stented patient in order to avoid coronary thrombosis at the cost of a small increase in non-major bleeding, or to ask that a previously scheduled intervention be postponed because of decompensated HF. However, in addition to a successful intervention in a high-risk patient, there is another reward: in a previous study, we discovered unsuspected cardiovascular diagnosis in 33% patients subjected to perioperative cardiology evaluation 8. This represents a new pathway of care and benefit for our patients.…”