Delay in cardiology consultation after primary care physician referrals in heart failure: Clinical implications
Sergio Cinza-Sanjurjo1,2,3,4, Alberto Cordero5,6, Pilar Mazón-Ramos2,3,4,7
1CS Milladoiro, Área Sanitaria Integrada Santiago de Compostela, A Coruña, Spain.
Insights
Delayed cardiology care after a primary care physician referral significantly increases 1-year mortality for heart failure patients. Prompt consultation is crucial for better heart failure outcomes and reduced hospital readmissions.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Heart failure (HF) management requires timely specialist intervention.
- Primary care physician (PCP) referrals are a key pathway to cardiology care.
- Understanding the impact of referral delays on patient outcomes is critical.
Purpose of the Study:
- To examine the association between the time to cardiology consultation post-PCP referral and 1-year mortality and hospitalization in HF patients.
- To quantify the risk associated with delayed cardiology care in heart failure management.
- To identify optimal timeframes for cardiology consultation to improve patient outcomes.
Main Methods:
- Analysis of electronic medical records for 68,518 PCP referrals to cardiology (2010-2021), including 6,379 with prior HF diagnosis.
- Utilized Cox regression models to assess the relationship between delay time and 1-year mortality and hospitalization.
- Adjusted for patient age, gender, and comorbidities in the statistical analysis.
Main Results:
- Each day of delay in cardiology care was associated with a significant increase in 1-year all-cause (0.25%), cardiovascular (0.13%), and HF (0.11%) mortality.
- Multivariate analysis confirmed continuous delay was independently linked to higher risks of all-cause, CV, and HF mortality (HR > 1.01, P < 0.01).
- Patients seen within 2 days (<25th quartile) had significantly lower mortality and HF readmission rates compared to those seen after 14 days (>75th quartile).
Conclusions:
- Delay in receiving cardiology care after a PCP referral for heart failure patients is significantly associated with increased 1-year all-cause, cardiovascular, and HF mortality.
- Prompt cardiology consultation is vital for improving survival and reducing adverse events in heart failure patients.
- These findings underscore the importance of efficient referral systems to optimize heart failure care and outcomes.
Aims:
To investigate the association between the elapsed time to cardiology care following a primary care physician (PCP) referral and 1 year outcomes among patients with heart failure (HF).
Methods:
Data from electronic medical records at our institution encompassing all PCP referrals to cardiology consultation from 2010 to 2021 (N = 68 518) were analysed. Of these, 6379 patients had a prior diagnosis of HF. Using a Cox regression model for hospitalization and mortality outcomes, the association between delay time in cardiology care post-PCP referral and 1 year outcomes was examined, adjusting for age, gender and comorbidities.
Results:
A significant increase in 1 year mortality rates with delayed cardiology care was observed for each day: all-cause (0.25%), cardiovascular (CV) (0.13%) and HF (0.11%). In multivariate analysis, continuous delay to consultation was independently associated with higher risk of all-cause [hazard ratio (HR): 1.02; 95% confidence interval (CI) (1.01-1.02); P < 0.01], CV [1.01 (1.00-1.02); P < 0.01] and HF mortality (HR: 1.01; 95% CI 1.00-1.03; P < 0.01). Patients attended in the 25th quartile of time delay (<2 days) had significantly lower mortality and HF readmission rates [1.21 (1.10-1.33); P < 0.01] as compared with patients in the 75th quartile (>14 days).
Conclusions:
Delay in cardiology assistance following a PCP referral among patients previously diagnosed with HF was associated with increased in all-cause, CV, and HF mortality at 1 year.
Related Concept Videos
01:30Cardiomyopathy II: Dilated Cardiomyopathy
01:30Heart Failure V: Medical Management
01:29Cardiomyopathy V: Interprofessional Care
01:21Rheumatic Heart Disease III: Medical Management
01:30Heart Failure V: Nursing Interventions
01:22Heart Failure VI: Adjunct Therapies