The continuity of care in Primary Care is associated with a better prognosis in heart failure patients referred to a cardiology department

Abstract Background The organization of continuity of care (COC) is one of the main characteristics of primary care. In this sense, COC by the same family physician (FP) has shown that it could provide beneficial results in reducing the rate of hospitalizations 1, emergency department visits2, reduction of the rate of referrals for outpatient care3 and mortality4. This prognostic impact can be of particular interest in the follow-up of patients with heart failure (HF) since it is a chronic pathology with frequent worsening episodes leading to hospitalization and high mortality. However, COC has traditionally been measured as the number of consultations in primary care without taking into account whether or not it is the same FP taking care of the patient. The aim of this study is to analyse whether the interruption of care continuity by the same FP influences the prognosis of HF patient referred to cardiology consultation. Methods The 5,899 patients, with previous HF diagnostic, referred to cardiology consultation by FP between 2010 and 2023 were included. COC was defined when the patient’s referral and follow-up were carried-out by the same FP. A multivariate analysis was performed, adjusted by other epidemiological and clinical characteristics, to analyse the association between COC on hospital admissions and mortality by calculating odds ratios (OR) and 95% confidence intervals (95%CI). Results A cohort of 5,899 patients with a history of HF were included in the analysis, of which 80.7% were referred and followed by their FP, who showed a lower cardiology consultation referral rate (1.5 (0.6) vs 2.4 (3.0), p0.001) compared with the group of patients referred and followed by different FPs. No differences were observed among both groups regarding sex (p=0.133), age (p=0.476), or other associated comorbidities like diabetes, ischemic heart disease or atrial fibrillation. The rate of hospitalization during the year before the referral to cardiology consultation was similar among both groups. Compared with the group of patients referred and followed by different FPs, the COC showed a lower risk of total hospitalizations (OR 95%CI: 0.85 0.76–0.95) as well as total mortality (0.89 0.80–1.00). However, the lack of COC by the same FP was associated with a higher rate of total (OR 95%CI: 1.58 1.32 - 1.89), CV (OR 95%CI: 1.64 1.27 - 2.12) and HF hospitalization (OR 95%CI: 1.78 1.19 - 2.65), as well as total (OR 95%CI: 1.66 1.42 - 1.94), CV (OR 95%CI: 2.65 2.02 - 3.48) and HF mortality (OR 95%CI: 2.27 1.61 - 3.19), figure. Conclusion The interruption of COC in patients with HF, assessed by the rotation of the FP, is associated, after multivariate adjustment, with higher rates of referral to cardiology consultation and higher rates of hospitalizations and mortality. Figure. Forrest plot of association between Family Physician rotation and the hospitalizations and mortality risks.