Key result
General medicine admission for HF shows no benefit over cardiology for days alive out of hospital.
Why the study?
Previous studies reported differing clinical outcomes for hospitalized HF patients admitted under cardiology versus general medicine without accounting for patient frailty.
Does admission under general medicine compared to cardiology affect days-alive-and-out-of-hospital and mortality in hospitalized heart failure patients?
Observational (n=4,913)
Yes
Does admission under general medicine compared to cardiology affect days-alive-and-out-of-hospital and mortality in hospitalized heart failure patients?
Effect estimate: coefficient -5.36 (95% CI -11.73 to 1.01)
p-value: p=0.099
After adjusting for frailty and other characteristics, clinical outcomes for heart failure patients are similar whether admitted under general medicine or cardiology.
Heart failure outcomes similar under general medicine or cardiology after adjustment; leaves open whether admission service affects DAOH90 in randomized trials.
BACKGROUND: Previous studies have reported differing clinical outcomes among hospitalized heart failure (HF) patients admitted under cardiology and general medicine (GM) without consideration of patients' frailty. AIMS: To explore outcomes in patients admitted under the two specialities after taking into account their frailty and other characteristics. METHODS: This retrospective study included all HF patients ≥18 years admitted between 1 January 2013 and 31 December 2019 at two Australian tertiary hospitals. Frailty was determined by use of the Hospital Frailty Risk Score (HFRS) and patients with HFRS ≥ 5 were classified as frail. Propensity score matching (PSM) was used to match 11 variables between the two specialities. The primary outcomes included the days-alive-and-out-of-hospital (DAOH90) at 90 days of discharge, 30-day mortality and readmissions. RESULTS: Of 4913 HF patients, mean age 76.2 (14.1) years, 51% males, 2653 (54%) were admitted under cardiology compared to 2260 (46%) under GM. Patients admitted under GM were more likely to be older females, with a higher Charlson index and poor renal function than those admitted under cardiology. Overall, 23.8% patients were frail and frail patients were more likely to be admitted under GM than cardiology (33.6% vs. 15.3%, P < 0.001). PSM created 1532 well-matched patients in each group. After PSM, the DAOH90 was not significantly different among patients admitted in GM when compared to cardiology (coefficient -5.36, 95% confidence interval -11.73 to 1.01, P = 0.099). Other clinical outcomes were also similar between the two specialities. CONCLUSIONS: Clinical characteristics of HF patients differ between GM and cardiology; however, clinical outcomes were not significantly different after taking into account frailty and other variables.
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Sharma et al. (2022) conducted an observational in Heart failure (n=4,913). Admission under general medicine vs. Admission under cardiology was evaluated on Days-alive-and-out-of-hospital (DAOH90) at 90 days of discharge (coefficient -5.36, 95% CI -11.73 to 1.01, p=0.099). Admission under general medicine versus cardiology for heart failure showed no significant difference in days-alive-and-out-of-hospital at 90 days (coefficient -5.36; 95% CI -11.73 to 1.01; P=0.099).
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