Article Text

  1. D. A. Garrow,
  2. J. Pino
  1. Wilmington, NC.


Background This study is designed to evaluate management, length of stay (LOS), and readmission rates (RRs) of patients cared for by a hospitalist, generalist, or cardiologist with congestive heart failure (CHF).

Methods Patients discharged with a primary diagnosis of CHF between 4/1/02 and 3/31/03 were identified for possible enrollment. A chart review was performed assessing: 1. Management. 2. LOS. 3. RRs. 211 patient admissions were reviewed. Fisher's exact testing was used for statistical analysis.

Results Patients' age and sex were evenly dispersed. Class III or IV CHF was seen in 48% of patients cared for by cardiologists, 35% by generalists, and 21.5% by hospitalists. Left ventricular ejection fraction (EF) was assessed 61% of the time by hospitalists, 43% by generalists, and 70% by cardiologists. With a cardiology consultation (CC), hospitalists increased to 91% and generalists to 85% (p = .122). LOS equaled 4.6 days for hospitalists, 4.8 days for generalists, and 4.3 days for cardiologists. CCs increased the hospitalist patient LOS to 5.1 days and generalists to 7.5 days (p = .041). ACE inhibitors/ARBs were prescribed by hospitalists 71% of the time, by generalists 48%, and by cardiologists 41%. CCs decreased the hospitalist rate to 69% and increased the generalists to 64% (p = .025). Diuretics were provided by hospitalists at a rate of 97%, by generalists 65%, and by cardiologists 100%. CCs increased hospitalists to 94% and generalists to 84%. Beta-blockers were written for 52% of hospitalist patients, 44% of generalist patients, and 60% of cardiologist patients. CCs increased these rates to 66% of hospitalist patients and 60% of generalist patients (p = .558). Digoxin was prescribed to 29% of hospitalist patients, 22% of generalist patients, and to 56% of cardiology patients. CCs kept the number at 29% for hospitalists and increased generalists to 33% (p = .010). RRs within a year were 39% for hospitalist patients, 44% for generalist patients, and 33% for cardiologist patients. CCs decreased these rates to 26% for hospitalist patients and 29% for generalist patients (p = .074).

Conclusions Cardiologists cared for patients with more severe heart failure. Cardiologists were more likely to assess EF. CCs added one-half day LOS to hospitalist patients and almost two days LOS to generalist patients. Hospitalists were more likely to use ACE inhibitors/ARBs. Cardiologists used ACE inhibitors significantly less. RRs were similar amongst the doctors. Adding a CC during the hospitalization led to a lower chance of readmission within a year.

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