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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