What does this research mean for the field?

Heart failure patients managed in general practice in Japan differ significantly from those managed in hospitals, presenting as older, more frequently female, receiving fewer evidence-based medications, and experiencing lower heart failure-related admission rates despite comparable mortality. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2007Circulation JournalOpen Access

Characteristics and Outcomes of Patients With Heart Failure in General Practices and Hospitals Japanese Cardiac Registry of Heart Failure in General Practice (JCARE-GENERAL)

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Why the study?

Does management by general practitioners compared to hospital cardiologists affect mortality and HF-related admissions in outpatients with heart failure?

Structured PICO

Does management by general practitioners compared to hospital cardiologists affect mortality and HF-related admissions in outpatients with heart failure?

Population

2,685 outpatients with heart failure (diagnosed by Framingham criteria), mean age 74, 46% male, in Japan.

Intervention

Management by primary care physicians in general practice (GP-HF)

Comparator

Management by cardiologists in hospital (Hospital-HF)

Outcome

All-cause death, cardiac death, and HF-related admission at 1 year follow-uphard clinical

Outpatients with heart failure managed in general practice are older, more often female, and have different etiologies and lower rates of evidence-based medication use compared to those managed in hospitals, but have comparable adjusted mortality and lower HF-related admission rates.

Limitations

Selection or referral bias (younger/more severe patients treated by hospital cardiologists)
Diagnosis based on Framingham criteria without source data validation
Lack of echocardiography data to differentiate reduced vs preserved EF
Cause of death not verified by death certificate
Unknown length between initial diagnosis and enrollment

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

GP management may suit selected HF outpatients; leaves open confounding and needs prospective confirmation before practice change.

Cite This Study

Tsutsui et al. (2007) studied this question.

synapsesocial.com/papers/6a1e03ca348274ea529fc068 https://doi.org/10.1253/circj.71.449

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Characteristics and Outcomes of Patients With Heart Failure in General Practices and Hospitals Japanese Cardiac Registry of Heart Failure in General Practice (JCARE-GENERAL)

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Characteristics and Outcomes of Patients With Heart Failure in General Practices and Hospitals Japanese Cardiac Registry of Heart Failure in General Practice (JCARE-GENERAL)

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider