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Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data.

Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data.
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Avaldi VM, Lenzi J, Urbinati S, Molinazzi D, Descovich C, Campagna A, Taglioni M, Fioritti A, Fantini MP,


Avaldi VM, Lenzi J, Urbinati S, Molinazzi D, Descovich C, Campagna A, Taglioni M, Fioritti A, Fantini MP, (click to view)

Avaldi VM, Lenzi J, Urbinati S, Molinazzi D, Descovich C, Campagna A, Taglioni M, Fioritti A, Fantini MP,

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BMJ open 2017 11 037(11) e018243 doi 10.1136/bmjopen-2017-018243
Abstract
OBJECTIVES
To evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF).

DESIGN
Retrospective observational study based on administrative data.

SETTING
Local Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants.

PARTICIPANTS
All patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015.

PRIMARY AND SECONDARY OUTCOME MEASURES
Multivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge.

RESULTS
The study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) were seen by a cardiologist during follow-up. Inpatient and outpatient cardiologist care was associated with an increased likelihood of adherence to ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and aldosterone antagonists after discharge. The risk of mortality was significantly lower among patients adherent to ACEIs/ARBs and/or β-blockers (-53% and -28%, respectively); the risk of hospital readmission was significantly lower among patients adherent to ACEIs/ARBs (-28%).

CONCLUSIONS
Compared with non-specialist care, cardiologist care improves patient adherence to evidence-based medications and might thus favourably affect mortality and readmission following HF.

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