Cargando…

Patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure

AIMS: Factors influencing follow‐up referral decisions and their prognostic implications are poorly investigated in patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF). We assessed (i) the proportion of, (ii) independent predic...

Descripción completa

Detalles Bibliográficos
Autores principales: Lindberg, Felix, Lund, Lars H., Benson, Lina, Schrage, Benedikt, Edner, Magnus, Dahlström, Ulf, Linde, Cecilia, Rosano, Giuseppe, Savarese, Gianluigi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934918/
https://www.ncbi.nlm.nih.gov/pubmed/35170237
http://dx.doi.org/10.1002/ehf2.13848
_version_ 1784671932566732800
author Lindberg, Felix
Lund, Lars H.
Benson, Lina
Schrage, Benedikt
Edner, Magnus
Dahlström, Ulf
Linde, Cecilia
Rosano, Giuseppe
Savarese, Gianluigi
author_facet Lindberg, Felix
Lund, Lars H.
Benson, Lina
Schrage, Benedikt
Edner, Magnus
Dahlström, Ulf
Linde, Cecilia
Rosano, Giuseppe
Savarese, Gianluigi
author_sort Lindberg, Felix
collection PubMed
description AIMS: Factors influencing follow‐up referral decisions and their prognostic implications are poorly investigated in patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF). We assessed (i) the proportion of, (ii) independent predictors of, and (iii) outcomes associated with follow‐up in specialty vs. primary care across the EF spectrum. METHODS AND RESULTS: We analysed 75 518 patients from the large and nationwide Swedish HF registry between 2000–2018. Multivariable logistic regression models were fitted to identify the independent predictors of planned follow‐up in specialty vs. primary care, and multivariable Cox models to assess the association between follow‐up type and outcomes. In this nationwide registry, 48 115 (64%) patients were planned for follow‐up in specialty and 27 403 (36%) in primary care. The median age was 76 [interquartile range (IQR) 67–83] years and 27 546 (36.5%) patients were female. Key independent predictors of planned follow‐up in specialty care included optimized HF care, that is follow‐up in a nurse‐led HF clinic [odds ratio (OR) 4.60, 95% confidence interval (95% CI) 4.41–4.79], use of HF devices (OR 3.99, 95% CI 3.62–4.40), beta‐blockers (OR 1.39, 95% CI 1.32–1.47), renin–angiotensin system/angiotensin‐receptor‐neprilysin inhibitors (OR 1.21, 95% CI 1.15–1.27), and mineralocorticoid receptor antagonists (OR 1.31, 95% CI 1.26–1.37); and more severe HF, that is higher NT‐proBNP (OR 1.13, 95% CI 1.06–1.20) and NYHA class (OR 1.13, 95% CI 1.08–1.19). Factors associated with lower likelihood of follow‐up in specialty care included older age (OR 0.29, 95% CI 0.28–0.30), female sex (OR 0.89, 95% CI 0.86–0.93), lower income (OR 0.79, 95% CI 0.76–0.82) and educational level (OR 0.77, 95% CI 0.73–0.81), higher EF [HFmrEF (OR 0.65, 95% CI 0.62–0.68) and HFpEF (OR 0.56, 95% CI 0.53–0.58) vs. HFrEF], and higher comorbidity burden, such as presence of kidney disease (OR 0.91, 95% CI 0.87–0.95), atrial fibrillation (OR 0.85, 95% CI 0.81–0.89), and diabetes mellitus (OR 0.92, 95% CI 0.88–0.96). A planned follow‐up in specialty care was independently associated with lower risk of all‐cause [hazard ratio (HR) 0.78, 95% CI 0.76–0.80] and cardiovascular death (HR 0.76, 95% CI 0.73–0.78) across the EF spectrum, but not of HF hospitalization (HR 1.06, 95% CI 1.03–1.10). CONCLUSIONS: In a large nationwide HF population, referral to specialty care was linked with male sex, younger age, lower EF, lower comorbidity burden, better socioeconomic environment and optimized HF care, and associated with better survival across the EF spectrum. Our findings highlight the need for greater and more equal access to HF specialty care and improved quality of primary care.
format Online
Article
Text
id pubmed-8934918
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-89349182022-03-24 Patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure Lindberg, Felix Lund, Lars H. Benson, Lina Schrage, Benedikt Edner, Magnus Dahlström, Ulf Linde, Cecilia Rosano, Giuseppe Savarese, Gianluigi ESC Heart Fail Original Articles AIMS: Factors influencing follow‐up referral decisions and their prognostic implications are poorly investigated in patients with heart failure (HF) with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF). We assessed (i) the proportion of, (ii) independent predictors of, and (iii) outcomes associated with follow‐up in specialty vs. primary care across the EF spectrum. METHODS AND RESULTS: We analysed 75 518 patients from the large and nationwide Swedish HF registry between 2000–2018. Multivariable logistic regression models were fitted to identify the independent predictors of planned follow‐up in specialty vs. primary care, and multivariable Cox models to assess the association between follow‐up type and outcomes. In this nationwide registry, 48 115 (64%) patients were planned for follow‐up in specialty and 27 403 (36%) in primary care. The median age was 76 [interquartile range (IQR) 67–83] years and 27 546 (36.5%) patients were female. Key independent predictors of planned follow‐up in specialty care included optimized HF care, that is follow‐up in a nurse‐led HF clinic [odds ratio (OR) 4.60, 95% confidence interval (95% CI) 4.41–4.79], use of HF devices (OR 3.99, 95% CI 3.62–4.40), beta‐blockers (OR 1.39, 95% CI 1.32–1.47), renin–angiotensin system/angiotensin‐receptor‐neprilysin inhibitors (OR 1.21, 95% CI 1.15–1.27), and mineralocorticoid receptor antagonists (OR 1.31, 95% CI 1.26–1.37); and more severe HF, that is higher NT‐proBNP (OR 1.13, 95% CI 1.06–1.20) and NYHA class (OR 1.13, 95% CI 1.08–1.19). Factors associated with lower likelihood of follow‐up in specialty care included older age (OR 0.29, 95% CI 0.28–0.30), female sex (OR 0.89, 95% CI 0.86–0.93), lower income (OR 0.79, 95% CI 0.76–0.82) and educational level (OR 0.77, 95% CI 0.73–0.81), higher EF [HFmrEF (OR 0.65, 95% CI 0.62–0.68) and HFpEF (OR 0.56, 95% CI 0.53–0.58) vs. HFrEF], and higher comorbidity burden, such as presence of kidney disease (OR 0.91, 95% CI 0.87–0.95), atrial fibrillation (OR 0.85, 95% CI 0.81–0.89), and diabetes mellitus (OR 0.92, 95% CI 0.88–0.96). A planned follow‐up in specialty care was independently associated with lower risk of all‐cause [hazard ratio (HR) 0.78, 95% CI 0.76–0.80] and cardiovascular death (HR 0.76, 95% CI 0.73–0.78) across the EF spectrum, but not of HF hospitalization (HR 1.06, 95% CI 1.03–1.10). CONCLUSIONS: In a large nationwide HF population, referral to specialty care was linked with male sex, younger age, lower EF, lower comorbidity burden, better socioeconomic environment and optimized HF care, and associated with better survival across the EF spectrum. Our findings highlight the need for greater and more equal access to HF specialty care and improved quality of primary care. John Wiley and Sons Inc. 2022-02-15 /pmc/articles/PMC8934918/ /pubmed/35170237 http://dx.doi.org/10.1002/ehf2.13848 Text en © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Articles
Lindberg, Felix
Lund, Lars H.
Benson, Lina
Schrage, Benedikt
Edner, Magnus
Dahlström, Ulf
Linde, Cecilia
Rosano, Giuseppe
Savarese, Gianluigi
Patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure
title Patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure
title_full Patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure
title_fullStr Patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure
title_full_unstemmed Patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure
title_short Patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure
title_sort patient profile and outcomes associated with follow‐up in specialty vs. primary care in heart failure
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934918/
https://www.ncbi.nlm.nih.gov/pubmed/35170237
http://dx.doi.org/10.1002/ehf2.13848
work_keys_str_mv AT lindbergfelix patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure
AT lundlarsh patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure
AT bensonlina patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure
AT schragebenedikt patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure
AT ednermagnus patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure
AT dahlstromulf patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure
AT lindececilia patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure
AT rosanogiuseppe patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure
AT savaresegianluigi patientprofileandoutcomesassociatedwithfollowupinspecialtyvsprimarycareinheartfailure