An analysis of physicians' reasons for prescribing long-term digitalis therapy in outpatients

Carlson, Karen J.; Lee, Daniel C.-S.; Goroll, Allan H.; Leahy, Marianne; Johnson, Robert A.

doi:10.1016/0021-9681(85)90115-8

Cited by 204 publications

(130 citation statements)

References 18 publications

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“…Trained abstractors, who were blinded to the original data, reviewed randomly selected charts of patients with first-time hospitalization for heart failure between April 1, 1997, and March 31, 1999. We applied the Framingham criteria 13 and the Carlson heart failure score 14 to ascertain the diagnosis of heart failure on admission. The diagnosis of heart failure was confirmed if 2 major or 1 major and 2 minor Framingham criteria were concurrently present or alternatively if the Carlson heart failure score exceeded 4 points.…”

Section: Quality Of Administrative Databasesmentioning

confidence: 99%

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

et al. 2003

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Background-It is not known whether subspecialty care by cardiologists improves outcomes in heart failure patients from the community over care by other physicians. Methods and Results-Using administrative data, we monitored 38 702 consecutive patients with first-time hospitalization for heart failure in Ontario, Canada, between April 1994 and March 1996 and examined differences in processes of care and clinical outcomes between patients attended by physicians of different disciplines. We found that patients attended by cardiologists had lower 1-year risk-adjusted mortality than those attended by general internists, family practitioners, and other physicians (28.5% versus 31.7%, 34.9%, and 35.9%, respectively; all pairwise comparisons, PϽ0.001). The 1-year risk-adjusted composite outcome of death and readmission for heart failure was also lower for the cardiologists compared with family practitioners and other physicians but not general internists (54.7% versus 58.1%, 58.3%, and 55.4%; PϽ0.001, PϽ0.001, and Pϭ0.39, respectively). Multivariable hierarchical modeling demonstrated a significant physician-level effect for both outcomes in favor of the cardiologists, particularly against non-general internists.Cardiologist care was associated with higher adjusted rates of invasive interventions and postdischarge prescriptions of heart failure medications. Conclusions-In this population-based cohort, heart failure patients attended by cardiologists in hospital had lower risk of death as well as the composite risk of death or readmission than patients attended by noncardiologists. These data raise the need to identify specialty-driven differences in processes of care for heart failure patients, which may explain the observed disparity in clinical outcomes that presently favor cardiologist care.

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Section: Quality Of Administrative Databasesmentioning

confidence: 99%

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

et al. 2003

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“…O diagnósti-co, sempre feito por um cardiologista, foi baseado nos crité-rios de Boston 15 , tendo sido incluído apenas aqueles cuja pontuação permitia um diagnóstico definitivo de ICC. A classe funcional (CF) no momento do atendimento foi estabelecida de acordo com critérios da New York Heart Association (NYHA).…”

Section: Métodosunclassified

Evolução intra-hospitalar e seguimento pós-alta de pacientes idosos atendidos com insuficiência cardíaca congestiva na unidade de emergência

Villacorta¹,

Rocha²,

Cardoso³

et al. 1998

Arq. Bras. Cardiol.

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Purpose -To evaluate the in-hospital (IH) outcome and the short-term follow-up of predominantly elderly patients presenting to an emergency room (ER) with congestive heart failure (CHF). Methods -In an 11 month period, 57 patients presenting to the ER with CHF were included. Mean age was 69+15 years (27 to 94) and 39 (68,4%) A síndrome de insuficiência cardíaca congestiva (ICC) apresenta prevalência de 1 a 2% na população geral 1-3 . Em indivíduos com idades entre 65 e 67 anos, esse número eleva-se para 23% 4 , tornando-se problema sério em idosos. Nos Estados Unidos é a principal causa de internação em

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“…A random sample of 6300 patients, aged over 25 years, attending their general practitioner for a variety of medical compliants was obtained during 1998 in Portugal. Patients with symptoms and/or signs of heart failure, who scored 2 or more points in the Boston questionnaire (sum of parts I and II) [16], and/or who were receiving diuretics for the management of heart failure were investigated further by chest radiography, ECG, haematology, biochemistry, and an echocardiogram.…”

Section: Methodsmentioning

confidence: 99%

The value of the electrocardiogram and chest X‐ray for confirming or refuting a suspected diagnosis of heart failure in the community

Fonseca

Mota

Morais³

et al. 2004

European J of Heart Fail

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Background: There is a common assumption that a normal ECG or a normal heart size on chest X-ray virtually rules out a diagnosis of heart failure. Aims: To assess the value of the electrocardiogram and chest X-ray in identifying patients with chronic heart failure in the community. Methods and results: This study was a secondary analysis of data prospectively collected at the time of patient's enrolment in the EPICA study, an epidemiological study of the prevalence of heart failure in Portugal. A total of 6300 subjects were clinically evaluated. Patients who presented with symptoms or signs of heart failure, and/or were receiving diuretics for chronic heart failure (CHF) had a chest X-ray, ECG, and echocardiogram. The diagnosis of heart failure was confirmed in 551 cases. Patients with right atrial enlargement, atrial flutter, atrial fibrillation, 2nd degree-Mobitz I atrioventricular block, 1st degree atrioventricular block, left bundle branch block, lung interstitial oedema, and bilateral pleural effusion were more likely to be diagnosed with heart failure. For the diagnosis of heart failure, in the Portuguese population aged over 25 years, an abnormal electrocardiogram had an estimated sensitivity of 81%, and negative predictive value of 75%; an abnormal chest X-ray had an estimated sensitivity of 57%, and negative predictive value of 83%. Twenty five percent of patients with CHF had a normal ECG or chest X-ray. Conclusion: Our results show that electrocardiographic and roentgenographic features are not sufficient to allow heart failure to be reliably predicted in the community and support the recommendation that all patients with suspected heart failure should undergo echocardiography.

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An analysis of physicians' reasons for prescribing long-term digitalis therapy in outpatients

Cited by 204 publications

References 18 publications

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

Care and Outcomes of Patients Newly Hospitalized for Heart Failure in the Community Treated by Cardiologists Compared With Other Specialists

Evolução intra-hospitalar e seguimento pós-alta de pacientes idosos atendidos com insuficiência cardíaca congestiva na unidade de emergência

The value of the electrocardiogram and chest X‐ray for confirming or refuting a suspected diagnosis of heart failure in the community

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