Management of older patients with heart failure by general physicians significantly reduced the odds of death (OR 0.62) compared to management by internal medicine physicians.
Cohort (n=1,032)
No
Does management by general physicians reduce mortality and hospitalization in older patients with heart failure compared to internal medicine physicians?
Comprehensive management of older patients with heart failure and multimorbidity by general physicians may be associated with lower mortality and hospitalization rates compared to management by internal medicine physicians.
Effect estimate: OR 0.62 (95% CI 0.44-0.86)
Absolute Event Rate: 19.5% vs 23.1%
p-value: p=0.004
BACKGROUND: The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates. METHODS: This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors. RESULTS: A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio OR, 0.62) and hospitalization (OR, 0.73). CONCLUSIONS: In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities.
Nishikawa et al. (Thu,) conducted a cohort in Heart failure (n=1,032). Management by general physicians vs. Management by internal medicine physicians was evaluated on Death (OR 0.62, 95% CI 0.44-0.86, p=0.004). Management of older patients with heart failure by general physicians significantly reduced the odds of death (OR 0.62) compared to management by internal medicine physicians.