"We need to find ways to improve timely and appropriate access to specialists and to improve the structuring of collaborative care," said Dr. Paul Armstrong, professor of medicine in the University of Alberta's division of cardiology, and one of the study's authors.
The researchers discovered that patients discharged after their first hospital stay for heart failure had significantly better outcomes if they received regular cardiovascular follow-up visits with a physician. Those who saw both a family practitioner and a specialist had the lowest mortality rates, even with more complicated conditions. Outpatient care involving both a specialist and a family physician was associated with a 66 per cent drop in the risk of one-year mortality.
"Unfortunately, we found that patients who were elderly and living in rural areas had less access to specialty care. We now know that only a minority of heart failure patients are seen in specialty heart failure clinics where it has been shown that outcomes are improved. These clinics tend to be located in specialty academic centres, which can be difficult for rural patients to access," said Dr. Armstrong.
Results from the two-year study, which also included research from the University of Ottawa, were published recently in the Canadian Medical Association Journal.
The population-based study followed 3,136 patients who were newly diagnosed with congestive heart failure and had just been discharged from 128 Alberta hospitals. Of the patients, 34 per cent received no follow-up visits for cardiovascular care, 24 per cent were seen by a family doctor alone, one per cent by a specialist and 42 per cent by both a family physician and a specialist.