Coordinated Care Approach May Be Best for Patients with Heart Failure


A new study that found no association between increased levels of hospitalist or cardiologist care and improved 30-day outcomes in older patients with heart failure might mean a coordinated approach is best, says the report’s lead author.

Associations Between Use of the Hospitalist Model and Quality of Care and Outcomes of Older Patients Hospitalized for Heart Failure,” published in JACC Heart Failure, analyzed data from a heart-failure registry that included 31,505 Medicare beneficiaries in 166 hospitals.

After multivariable adjustment, researchers found that a 10% increase in the use of hospitalists was not related to an improvement in 30-day readmission rates, but it was linked to a slight increase in mortality (risk ratio: 1.03; 95% confidence interval [CI]: 1.00 to 1.06) and a decrease in length of stay (0.09 days; 95% CI: 0.02 to 0.16).

Similar results for 30-day readmission rates were found when care was associated with a 10% increase in the use of cardiologists, prompting lead author and cardiologist Robb Kociol, MD, to suggest that perhaps a hybrid model using both HM and cardiologist specialists may improve outcomes.

"Comanagement, or commingling of hospitalist and cardiologist care, in these patients may improve at least adherence to measures we know are associated with improved quality of care," says Dr. Kociol, director of advanced-heart-failure and ventricular-assist devices at the CardioVascular Institute at Beth Israel Deaconess Medical Center in Boston.

The paper also reported that increased use of hospitalists in hospitals with high use of cardiologists was associated with improved defect-free adherence to a composite of heart failure performance measures (risk ratio: 1.03; 95% CI: 1.01 to 1.06). Dr. Kociol says further research is needed to tease out just how a hybrid model of hospitalist-cardiologist care would work.

"One model might be that all of these patients are cared for by hospitalists with automatic cardiology consultation," he adds. "Or maybe we find a way to risk-stratify which patients are under the hospitalist service and which patients are cared for by cardiologists. None of those questions are answered in this analysis, but the paper does suggest there may be something that needs to be studied further."

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