Clinical Inertia in Terms of Recurrent Hospitalization in the Treatment of Heart Failure Between General Physicians and Cardiologists : Clinical Inertia in Terms of Recurrent Hospitalization in the Treatment of Heart Failure

Kaleem Ullah Shaikh; Abeer Sarfaraz; Sana Sarfaraz; Muhammad Wasiq Anwar; Falaknaz Salari; Faryal Fatima

doi:10.54393/pbmj.v7i01.1025

Authors

Kaleem Ullah Shaikh Department of Cardiology, Liaquat National Hospital and Medical College, Karachi, Pakistan
Abeer Sarfaraz Department of Cardiology, Liaquat National Hospital and Medical College, Karachi, Pakistan
Sana Sarfaraz Department of Pharmacology and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
Muhammad Wasiq Anwar Department of Cardiology, Liaquat National Hospital and Medical College, Karachi, Pakistan
Falaknaz Salari Department of Cardiology, Liaquat National Hospital and Medical College, Karachi, Pakistan
Faryal Fatima Department of Cardiology, Liaquat National Hospital and Medical College, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pbmj.v7i01.1025

Abstract

Cardiologists are more likely to use clinical guideline-supported therapies than general physicians, a fact that has been shown to reduce readmissions. Objective: To compare the intensification of heart failure treatment and its course with re-hospitalization among general physicians and cardiologists at a tertiary care hospital. Methodology: An observational cross-sectional study was conducted in the cardiology inpatient department of a tertiary care hospital from June 2023 to December 2023 for six months. All patients admitted with acute decompensated heart failure with reduced ejection fraction were included. The treatment prescriptions that they had been followed before the event were noted along with the fact that whether they were treated by a cardiologist or a general physician, and their compliance with medical treatment was recorded. Frequencies and percentages were computed for qualitative variables. Results: A statistically significant association of re-admission was observed among cardiologists (1.40 ± 0.57) compared to general physicians (2.54 ± 0.57; p<0.001). Almost 100% of cardiologists advised beta blockers as compared to their prescription by 42% of general physicians. All cardiologists advised ARBS/ACE inhibitors as compared to 58% of general physicians. 90% of cardiologists advised aldosterone receptor antagonists as compared to 10% of general physicians. Only 12% of cardiologists advised SGLT-2 inhibitors as compared to 88% of physicians. Overall, 36% of cardiologists recommended guideline-mediated therapy while 12% of general physicians recommended guideline-mediated therapy. Conclusions: Cardiologist care is significantly associated with reduced re-admissions among patients re-admitted after heart failure treatment.

References

Savarese G, Stolfo D, Sinagra G, Lund LH. Heart failure with mid-range or mildly reduced ejection fraction. Nature Reviews Cardiology. 2022 Feb; 19(2): 100-16. doi: 10.1038/s41569-021-00605-5. DOI: https://doi.org/10.1038/s41569-021-00605-5

Verhestraeten C, Heggermont WA, Maris M. Clinical inertia in the treatment of heart failure: a major issue to tackle. Heart Failure Reviews. 2021 Nov; 26: 1359-70. doi: 10.1007/s10741-020-09979-z. DOI: https://doi.org/10.1007/s10741-020-09979-z

Zahid FM, Ramzan S, Faisal S, Hussain I. Gender based survival prediction models for heart failure patients: A case study in Pakistan. PloS one. 2019 Feb; 14(2): e0210602. doi: 10.1371/journal.pone.0210602. DOI: https://doi.org/10.1371/journal.pone.0210602

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Kardiologia Polska (Polish Heart Journal). 2016; 74(10): 1037-147. doi: 10.5603/KP.2016.0141. DOI: https://doi.org/10.5603/KP.2016.0141

Uthamalingam S, Kandala J, Selvaraj V, Martin W, Daley M, Patvardhan E et al. Outcomes of patients with acute decompensated heart failure managed by cardiologists versus non-cardiologists. The American journal of cardiology. 2015 Feb; 115(4): 466-71. doi: 10.1016/j.amjcard.2014.11.034. DOI: https://doi.org/10.1016/j.amjcard.2014.11.034

Bhosale KH, Nath RK, Pandit N, Agarwal P, Khairnar S, Yadav B et al. Rate of Rehospitalization in 60 Days of Discharge and It's Determinants in Patients with Heart Failure with Reduced Ejection Fraction in a Tertiary Care Centre in India. International Journal of Heart Failure. 2020 Apr; 2(2): 131. doi: 10.36628/ijhf.2020.0007. DOI: https://doi.org/10.36628/ijhf.2020.0007

Álvarez-García J., Salamanca-Bautista P., Ferrero-Gregori A., Montero-Pérez-Barquero M., Puig T., Aramburu-Bodas Ó., et al. Prognostic impact of physician specialty on the prognosis of outpatients with heart failure: propensity matched analysis of the REDINSCOR and RICA registries. Revista Española de Cardiología. 2017 May; 70(5): 347-354. doi: 10.1016/j.rec.2016.12.026. DOI: https://doi.org/10.1016/j.rec.2016.12.026

Sadiq AM, Chamba NG, Sadiq AM, Shao ER, Temu GA. Clinical characteristics and factors associated with heart failure readmission at a tertiary hospital in North-Eastern Tanzania. Cardiology Research and Practice. 2020 Apr; 2020. doi: 10.1155/2020/2562593. DOI: https://doi.org/10.1155/2020/2562593

Lenzi J, Avaldi VM, Molinazzi D, Descovich C, Urbinati S, Cappelli V, et al. Are degree of urbanisation and travel times to healthcare services associated with the processes of care and outcomes of heart failure? A retrospective cohort study based on administrative data. Plos one. 2019 Oct; 14(10): e0223845. doi: 10.1371/journal.pone.0223845. DOI: https://doi.org/10.1371/journal.pone.0223845

Bekelman DB, Allen LA, McBryde CF, Hattler B, Fairclough DL, Havranek EP, et al. Effect of a collaborative care intervention vs usual care on health status of patients with chronic heart failure: the CASA randomized clinical trial. JAMA Internal Medicine. 2018 Apr; 178(4): 511-9. doi: 10.1001/jamainternmed.2017.8667. DOI: https://doi.org/10.1001/jamainternmed.2017.8667

Tung YC, Chang GM, Chang HY, Yu TH. Relationship between early physician follow-up and 30-day readmission after acute myocardial infarction and heart failure. PLoS One. 2017 Jan; 12(1): e0170061. doi: 10.1371/journal.pone.0170061. DOI: https://doi.org/10.1371/journal.pone.0170061

Saxena FE, Bierman AS, Glazier RH, Wang X, Guan J, Lee DS, et al. Association of Early Physician Follow-up with Readmission Among Patients Hospitalized for Acute Myocardial Infarction, Congestive Heart Failure, or Chronic Obstructive Pulmonary Disease. JAMA Network Open. 2022 Jul; 5(7): e2222056. doi: 10.1001/jamanetworkopen.2022.22056. DOI: https://doi.org/10.1001/jamanetworkopen.2022.22056

Dabscheck E, George J, Hermann K, McDonald CF, McDonald VM, McNamara R, et al. COPD‐X Australian guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2022 update. Medical Journal of Australia. 2022 Oct; 217(8): 415-23. doi: 10.5694/mja2.51708. DOI: https://doi.org/10.5694/mja2.51708

Huynh K. Dapagliflozin—a breakthrough in the search for drugs to treat HFrEF. Nature Reviews Cardiology. 2019 Dec; 16(12): 700. doi: 10.1038/s41569-019-0291-1. DOI: https://doi.org/10.1038/s41569-019-0291-1

Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. New England Journal of Medicine. 2020 Oct; 383(15): 1413-24.

Smeets M, Zervas S, Leben H, Vermandere M, Janssens S, Mullens W, et al. General practitioners’ perceptions about their role in current and future heart failure care: an exploratory qualitative study. BMC Health Services Research. 2019 Dec; 19(432): 1-0. doi: 10.1186/s12913-019-4271-2. DOI: https://doi.org/10.1186/s12913-019-4271-2

Smeets M, Van Roy S, Aertgeerts B, Vermandere M, Vaes B. Improving care for heart failure patients in primary care, GPs' perceptions: a qualitative evidence synthesis. BMJ Open. 2016 Nov; 6(11): e013459. doi: 10.1136/bmjopen-2016-013459. DOI: https://doi.org/10.1136/bmjopen-2016-013459

Hancock HC, Close H, Fuat A, Murphy JJ, Hungin AP, Mason JM. Barriers to accurate diagnosis and effective management of heart failure have not changed in the past 10 years: a qualitative study and national survey. BMJ Open. 2014 Apr; 4(3): e003866. doi: 10.1136/bmjopen-2013-003866. DOI: https://doi.org/10.1136/bmjopen-2013-003866

Wu YM, Liu CC, Yeh CC, Sung LC, Lin CS, Cherng YG, et al. Hospitalization outcome of heart diseases between patients who received medical care by cardiologists and non-cardiologist physicians: A propensity-score matched study. PLoS One. 2020 Jul; 15(7): e0235207. doi: 10.1371/journal.pone.0235207. DOI: https://doi.org/10.1371/journal.pone.0235207

Driscoll A, Meagher S, Kennedy R, Hay M, Banerji J, Campbell D, et al. What is the impact of systems of care for heart failure on patients diagnosed with heart failure: a systematic review. BMC Cardiovascular Disorders. 2016 Dec; 16(1): 1-20. doi: 10.1186/s12872-016-0371-7. DOI: https://doi.org/10.1186/s12872-016-0371-7