Characteristics of current heart failure patients admitted to internal medicine vs. cardiology hospital units: the VASCO study

Ricciardi, Elisa; Malfa, Giovanni La; Guglielmi, G; Cenni, E.; Micali, Marco; Corsello, Luca Moisio; Lopena, Patrizia; Manco, Luca; Pontremoli, Roberto; Moscatelli, P; Murdaca, Giuseppe; Musso, Natale R.; Montecucco, Fabrizio; Ameri, Pietro; Porto, Italo; Pende, Aldo; Canepa, Marco

doi:10.1007/s11739-020-02304-4

Cited by 19 publications

(16 citation statements)

References 33 publications

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“…These studies reported unadjusted differences between patients treated by cardiologists vs noncardiologists, thus being subject to confounding. For example, older patients may have more comorbidities which are better and more holistically served by generalists and may also reduce the benefits of HF therapy over time [19][20][21].…”

Section: Associations Between Patient Characteristics and Type Of Carementioning

confidence: 99%

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

Kapelios

Canepa

Benson

et al. 2021

International Journal of Cardiology

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Background: Patients with heart failure (HF) are often cared for by non-cardiologists. The implications are unknown. Methods: In a nationwide HF cohort with reduced ejection fraction (HFrEF), we compared demographics, clinical characteristics, guideline-based therapy use and outcomes in non-cardiology vs. cardiology in-patient and outpatient care. Results: Between 2000 and 2016, 36,076 patients with HFrEF were enrolled in the Swedish HF registry (19,337 [54%] in-patients overall), with 44% of in-patients and 45% of out-patients managed in non-cardiology settings. Predictors of treatment in non-cardiology were age > 75 years (adjusted odds ratio for non-cardiology 1.20; 95% confidence interval 1.14-1.27), lower education level (0.71; 0.66-0.76 for university vs. compulsory), valve disease (1.24; 1.18-1.31) and systolic blood pressure (SBP) >120 mmHg (1.05; 1.00-1.10). Non-cardiology care was significantly associated with lower use of beta-blockers (0.80; 0.74-0.86) and devices (intracardiac defibrillator [ICD] and/or cardiac resynchronization therapy [CRT]: 0.63; 0.56-0.71), and less frequent specialist follow-up (0.61; 0.57-0.65). Over 1-year follow-up the risk of all-cause mortality (adjusted hazard ratio 1.09; 1.03-1.15) was higher but the risk of first HF (re-) hospitalization was lower (0.93; 0.89-0.97) in non-cardiology vs. cardiology care. Conclusions: In HFrEF, non-cardiology care was independently associated with older ageand lower education. After covariate adjustment, non-cardiology care was associated with lower use of beta-blockers and devices, higher mortality, and lower risk of HF hospitalization. Access to cardiology care may not be equitable and this may have implications for use of guideline-based care and outcomes.

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Section: Associations Between Patient Characteristics and Type Of Carementioning

confidence: 99%

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

Kapelios

Canepa

Benson

et al. 2021

International Journal of Cardiology

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“…Beyond the interaction of ward type with the sensitivity of HF diagnosis, 2 recent data show that a preferential pathway to cardiology wards is increasingly reserved for new-onset primarily HFrEF patients admitted for acute coronary events, shock, and/or arrhythmias, whereas worsening primarily HFpEF patients with congestion, infections and/or lung diseases are more frequently managed in non-cardiology settings. 5 In this light, the opposite interaction between atrial fibrillation and outcomes in new-onset vs. worsening HF reported by Butt et al has a potential interpretation. Indeed, atrial fibrillation provides an easily diagnosable and treatable cause of instability in new-onset HF, which is sometimes more difficult to be determined in patients with chronic worsening HF, in which multiple non-cardiac comorbidities seem to play a major role.…”

mentioning

confidence: 96%

Acknowledging the complex puzzle that links heart failure hospitalizations to outcomes. Letter regarding the article ‘Readmission and death in patients admitted with new‐onset versus worsening of chronic heart failure: insights from a nationwide cohort’

Canepa

Kapelios

Lund

2020

European J of Heart Fail

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“…Indeed, in the current study, the number of patients ≥85 years and their mean age is higher than that analyzed in previous reports, either in Italy or Europe [5,13,16]. Furthermore, at odds with previous studies based on registries and surveys [5,19], we considered exclusively patients admitted to internal medicine wards as it has been documented that those admitted to cardiology units are a selected group of younger patients with significant differences in clinical characteristics and outcomes, in Italy and elsewhere [20,21].…”

Section: Discussionmentioning

confidence: 83%

Clinical Characteristics and Predictors of In-Hospital Mortality among Older Patients with Acute Heart Failure

Matteis

Covino

Burzo

et al. 2022

JCM

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Acute Heart Failure (AHF)-related hospitalizations and mortality are still high in western countries, especially among older patients. This study aimed to describe the clinical characteristics and predictors of in-hospital mortality of older patients hospitalized with AHF. We conducted a retrospective study including all consecutive patients ≥65 years who were admitted for AHF at a single academic medical center between 1 January 2008 and 31 December 2018. The primary outcome was all-cause, in-hospital mortality. We also analyzed deaths due to cardiovascular (CV) and non-CV causes and compared early in-hospital events. The study included 6930 patients, mean age 81 years, 51% females. The overall mortality rate was 13%. Patients ≥85 years had higher mortality and early death rate than younger patients. Infections were the most common condition precipitating AHF in our cohort, and pneumonia was the most frequent of these. About half of all hospital deaths were due to non-CV causes. After adjusting for confounding factors other than NYHA class at admission, infections were associated with an almost two-fold increased risk of mortality, HR 1.74, 95% CI 1.10–2.71 in patients 65–74 years (p = 0.014); HR 1.83, 95% CI 1.34–2.49 in patients 75–84 years (p = 0.001); HR 1.74, 95% CI 1.24–2.19 in patients ≥85 years (p = 0.001). In conclusion, among older patients with AHF, in-hospital mortality rates increased with increasing age, and infections were associated with an increased risk of in-hospital mortality. In contemporary patients with AHF, along with the treatment of the CV conditions, management should be focused on timely diagnosis and appropriate treatment of non-CV factors, especially pulmonary infections.

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Characteristics of current heart failure patients admitted to internal medicine vs. cardiology hospital units: the VASCO study

Cited by 19 publications

References 33 publications

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

Acknowledging the complex puzzle that links heart failure hospitalizations to outcomes. Letter regarding the article ‘Readmission and death in patients admitted with new‐onset versus worsening of chronic heart failure: insights from a nationwide cohort’

Clinical Characteristics and Predictors of In-Hospital Mortality among Older Patients with Acute Heart Failure

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