Primary Care Docs Lag In Quality of HF Care


SEATTLE — Cardiologists outperformed internists, family physicians, and other specialists in meeting the measures of care for hospitalized patients with heart failure prescribed by the Joint Commission on Accreditation of Healthcare Organizations, Kismet D. Rasmusson reported.

A study of care within the 20-hospital Intermountain Healthcare system, which handled 2,000 admissions for a primary diagnosis of heart failure in 2005, assessed documentation of three aspects of care mandated by the Joint Commission (JCAHO) for evidence-based care of heart failure. Intermountain Healthcare employs about 400 physicians, mainly in primary care, and is affiliated with 2,500 more physicians, mainly specialists.

Results showed that internists cared for 31% of patients admitted for the first time with a primary diagnosis of heart failure during 2002–2006. Family physicians handled 19%, cardiologists or thoracic surgeons provided 22% of care, and other specialists handled the remainder of care for heart failure, she and her associates reported in a poster presentation.

Overall, 62% of cardiologists documented compliance with all three measures of heart failure care, compared with 43% of noncardiologists, said Ms. Rasmusson, a family nurse practitioner at LDS Hospital, Salt Lake City.

Noncardiologists were more likely to comply with only one, two, or none of the measures, documentation suggested.

The JCAHO requires documentation of four steps in caring for hospitalized heart failure patients:

1. Measurement of left ventricular function in the past, or planned measurement after discharge.

2. Prescription of an ACE inhibitor or an angiotensin receptor blocker when the left ventricular ejection fraction is 40% or lower, unless the drugs are contraindicated.

3. Providing self-management education to patients.

4. Providing smoking cessation counseling (the study did not include this measure because of the low numbers of smokers).

Previous studies have shown that compliance with these measures is associated with improved patient outcomes. “Health systems need to either increase the numbers of cardiologists providing heart failure care or improve care provided by noncardiologists,” the investigators concluded.

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