Key result
Withdrawal from a multidisciplinary heart failure pathway is linked to ~5.1-fold higher mortality in elderly patients.
Why the study?
General practitioners increasingly manage elderly patients with chronic heart failure in collaboration with hospital cardiologists, but little is known about how to collaborate and the resulting outcomes.
Does continuation in a local partnership clinical pathway (LPCP) with multidisciplinary care reduce all-cause death compared to pathway dropout in elderly patients with compensatory chronic heart failure?
Observational (n=500)
No
Does continuation in a local partnership clinical pathway (LPCP) with multidisciplinary care reduce all-cause death compared to pathway dropout in elderly patients with compensatory chronic heart failure?
In elderly patients with chronic heart failure managed via a regional collaborative clinical pathway between hospital specialists and local general practitioners, withdrawal from the pathway is strongly and independently associated with increased all-cause mortality.
Answers are grounded in this paper and cite their sources.
Pathway dropout associated with higher mortality in elderly HF; leaves open whether continued multidisciplinary care improves survival.
Heart failure (HF) is the most critical issue in the medical and long-term care for the elderly because HF is an economic and social burden due to its high prevalence and poor prognosis. General practitioners (GPs) have recently managed patients with chronic HF (CHF) in collaboration with hospital cardiologists. However, little is known about how to collaborate and its outcomes.We have operated a local partnership program using clinical pathway (LPCP) for CHF to facilitate medical and nursing care teamwork in the local community since June 2009. The hospital's multidisciplinary teams evaluate and share patient information periodically. Among 500 patients with available follow-up data as of December 2020, we defined patients who withdrew from the LPCP for reasons other than death as path-dropout (n = 164) and the remaining as path-continue patients (n = 336). The Kaplan-Meier method considering time co-variability of path-dropout, showed a significantly higher hazard ratio of all-cause death in the path-dropout group than in the path-continue group (HR: 5.09; 95% CI: 3.54-7.30, P < 0.001).LPCP provides integrated disease management for CHF by cardiologists and multidisciplinary professionals in the hospital collaborating with local GPs and home care teams. A multivariate analysis identified LPCP as the most important independent predictor of clinical outcome. LPCP may work as an observational tool to distinguish HF patient clinical outcomes.
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Yamamoto et al. (2025) conducted an observational in Chronic heart failure (n=500). Withdrawal from Local Partnership Clinical Pathway (path-dropout) vs. Continuation in Local Partnership Clinical Pathway (path-continue) was evaluated on All-cause death (HR 5.09, 95% CI 3.54-7.30, p=<0.001). Withdrawal from the local partnership clinical pathway was associated with a higher risk of all-cause death compared to continuing the pathway in elderly heart failure patients.
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