The continuity of care in primary care improves prognosis in patients referred to a cardiology department

Introduction The organization of continuity of care (COC) is one of the main characteristics of primary care. In this sense, continuity of care by the same family physician (FP) has shown that it could provide beneficial results in reducing the rate of hospitalizations 1 and mortality4. 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. In Spain, as other countries (United Kingdom, Norway, Netherland or Denmark), the FP has a group of patients assigned for the assistance in primary care, this group of patients are named quote. The aim of this setudy is to analyse whether the interruption of COC by the same FP influences the prognosis of patient referred to cardiology consultation. Methods The data of 75,831 patients referred to cardiology consultation by FP between 2010 and 2023, were available for this analysis. Of these patients, 67,889 were referred from primary care. 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 care continuity on hospital admissions and mortality by calculating odds ratios (OR) and 95% confidence intervals (95%CI). Results A cohort of 67,889 were included in the analysis, of which 80.5% were referred and followed by their FP, who showed a lower cardiology consultation referral rate (2.3 [2.9] vs 1.5 [0.6], p<0.001) compared with the group of patients referred and followed by different FPs. No differences were observed among both groups regarding 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 was associated to lower risk of total hospitalizations (OR [95%CI]: 0.90 [0.86-0.94]) as well as total mortality (0.84 [0.80-0.89]). However, the lack of care continuity by the same FP was associated with a higher rate of total (OR [95%CI]: 1.25 [1.16-1.34]), CV (OR [95%CI]: 1.32 [1.18-1.47]) and HF hospitalization (OR [95%CI]: 1.96 [1.32-2.92]), as well as total (OR [95%CI]: 1.39 [1.29-1.50]), CV (OR [95%CI]:1.38 [1.20-1.60) and HF mortality (OR [95%CI]: 1.53 [1.22-1.91]), figure. Conclusion The interruption of COC in patients referred to cardiology department, 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. Data represent odds ratio and CI95%. CV: cardiovascular; HF: heart failure.