Outcomes of Patients With Acute Decompensated Heart Failure Managed by Cardiologists Versus Noncardiologists

Uthamalingam, Shanmugam; Kandala, Jagdesh; Selvaraj, Vijairam; Martin, William G.; Daley, Marlyn; Patvardhan, Eshan; Capodilupo, Robert; Moore, Stephanie; Januzzi, James L.

doi:10.1016/j.amjcard.2014.11.034

Cited by 42 publications

(39 citation statements)

References 15 publications

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“…In light of the widespread availability and inexpensive nature of BB and RASi, our results have substantial global health implications: administering a combination of at least oral BB and RASi in all patients with AHF appears justified. As the care of hospitalized AHF patients is typically not in the hands of cardiology specialists, our data are applicable to a broad range of medical caregivers globally.…”

Section: Discussionmentioning

confidence: 99%

Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: a propensity‐score matched study

Gayat

Arrigo

Littnerová

et al. 2017

European J of Heart Fail

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Section: Discussionmentioning

confidence: 99%

Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: a propensity‐score matched study

Gayat

Arrigo

Littnerová

et al. 2017

European J of Heart Fail

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“…Yet, while the contemporary hospitalist model has yielded improved adherence to evidence-based therapies in several diseases, the impact is less clear in HF. A single-center study of 496 patients conducted about 10 years ago suggested that patients admitted to Cardiology services were less likely to be readmitted within 6 months compared to non-cardiology services[4]. Although the authors described higher rates of evidence-based therapies among Cardiology services as a potential contributor to this finding, other care transition processes associated with improved post-discharge outcomes such as the inclusion of specific elements on the discharge summary and outpatient follow-up were not evaluated.…”

mentioning

confidence: 99%

Discharge Processes and 30-Day Readmission Rates of Patients Hospitalized for Heart Failure on General Medicine and Cardiology Services

Salata

Sterling

Beecy

et al. 2018

The American Journal of Cardiology

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Given high rates of heart failure hospitalizations and widespread adoption of the hospitalist model, heart failure patients are often cared for on General Medicine (GM) services. Differences in discharge processes and 30-day readmission rates between patients on GM and those on Cardiology during the contemporary hospitalist era are unknown. This study aimed to compare discharge processes and 30-day readmission rates of heart failure patients admitted on GM services and those on Cardiology services. We retrospectively studied 926 patients discharged home following heart failure hospitalization. We performed chart abstraction for patient demographic and comorbidity data, hemodynamic indices, laboratory results, echocardiographic parameters, and discharge elements. The primary outcome was 30-day all-cause readmission following discharge from index hospitalization. Although the majority of patients with heart failure (60%) were admitted to Cardiology services, a substantial proportion (40%) were admitted to GM services. Prevalence of cardiovascular and non-cardiovascular comorbidities were similar between patients admitted to GM services and Cardiology services. Discharge summaries for patients on GM services were less likely to have reassessments of ejection fraction, new study results, weights, discharge vital signs, exams, and scheduled follow-up cardiologist appointments. In a multivariable regression analysis, patients on GM services were more likely to experience 30-day readmissions compared to those on Cardiology services (OR 1.43, [1.05-1.96], p=0.02). In conclusion, outcomes are better among those admitted to Cardiology services, signaling the need for studies and interventions focusing on non-cardiology hospital providers that care for heart failure patients.

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“…Several authors have demonstrated an association between low serum albumin and increased cardiovascular morbidity and mortality in patients with chronic HF 4, 10, 11, 12. Conversely, very few studies have examined the impact of hypoalbuminemia in the acute HF setting 10, 13.…”

Section: Introductionmentioning

confidence: 99%

“…Conversely, very few studies have examined the impact of hypoalbuminemia in the acute HF setting 10, 13. In elderly patients (>80 years)14, 15 and nonagenarians16 with acute HF, severe hypoalbuminemia represents a potential predictor of adverse in‐hospital outcome.…”

Section: Introductionmentioning

confidence: 99%

“…9 Several authors have demonstrated an association between low serum albumin and increased cardiovascular morbidity and mortality in patients with chronic HF. 4,[10][11][12] Conversely, very few studies have examined the impact of hypoalbuminemia in the acute HF setting. 10,13 In elderly patients (>80 years) 14,15 and nonagenarians 16 with acute HF, severe hypoalbuminemia represents a potential predictor of adverse in-hospital outcome.…”

Section: Introductionmentioning

confidence: 99%

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Serum albumin level and hospital mortality in acute non‐ischemic heart failure

et al. 2017

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AimsHypoalbuminemia is common in heart failure (HF), especially in elderly patients. It is associated with an increased risk of death. The present study sought to examine the prognostic significance of serum albumin level in the prediction of hospital mortality in patients admitted for acute non‐ischemic HF.Methods and resultsWe examined the association between albumin and hospital mortality in a cohort of 546 patients admitted for acute non‐ischemic HF. None of the patients had infectious disease, severe arrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation), required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Thirty‐six patients (7%) died during the hospital stay. These patients were significantly older (78 ± 9 vs. 72 ± 12 years; P = 0.006), had higher heart rate (P < 0.0001), increased creatinine level (P = 0.01), lower systolic and diastolic blood pressures (P < 0.05), elevated leucocyte count (P = 0.001), and lower albumin levels (31.3 ± 5.6 g/L vs. 36.9 ± 4.1 g/L; P < 0.001). With multivariable analysis, age (P = 0.01), heart rate (P < 0.0003), diastolic blood pressure (P < 0.01), leukocyte count (P = 0.009), and serum albumin level (P < 0.0001) emerged as independent predictors of hospital mortality. Hypoalbuminemia (<34 g/L) yielded the best sensitivity (78.8%) and specificity (75%) for predicting hospital death.ConclusionsSerum albumin level measured at admission can serve as a simple prognostic factor in acute non‐ischemic HF. Hypoalbuminemia is associated with increased risk of hospital mortality, especially in elderly patients.

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Outcomes of Patients With Acute Decompensated Heart Failure Managed by Cardiologists Versus Noncardiologists

Cited by 42 publications

References 15 publications

Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: a propensity‐score matched study

Heart failure oral therapies at discharge are associated with better outcome in acute heart failure: a propensity‐score matched study

Discharge Processes and 30-Day Readmission Rates of Patients Hospitalized for Heart Failure on General Medicine and Cardiology Services

Serum albumin level and hospital mortality in acute non‐ischemic heart failure

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