Key result
Higher annual HF admissions per cardiologist linked to ~4% higher in-hospital mortality per 50 admissions.
Why the study?
While hospital volume is thought to associate with quality of care and outcomes in heart failure, whether annual heart failure admissions per cardiologist associate with process of care, mortality, and readmission was unclear.
Does higher annual patient volume per cardiologist worsen process of care and clinical outcomes in adult patients with heart failure?
Population
1 127 113 adult patients with HF across 1046 hospitals in Japan
Comparison
Annual admissions of HF per cardiologist (evaluated per interval of 50 annual admissions)
Design
Nationwide registry-based observational study
Follow-up
6 months
Authors
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Hypothesis-generating for cardiologist caseload effects on HF outcomes; should not yet change practice or staffing policies.
Observational (n=1,127,113)
Yes
Does higher annual patient volume per cardiologist worsen process of care and clinical outcomes in adult patients with heart failure?
Effect estimate: OR 1.04 (95% CI 1.04-1.08)
p-value: p=0.04
Higher annual heart failure patient volume per cardiologist (especially >300/year) is associated with worse guideline-directed medical therapy prescription rates and increased mortality and readmission risks.
Nishi et al. (2023) conducted an observational in Heart failure (n=1,127,113). Annual admissions of heart failure per cardiologist was evaluated on In-hospital mortality (OR 1.04, 95% CI 1.04-1.08, p=0.04). Higher annual admissions of heart failure per cardiologist (per 50 admissions) were associated with increased in-hospital mortality (OR 1.04; 95% CI 1.04-1.08; P=0.04) and worse process of care.
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