Elsevier

International Journal of Cardiology

Volume 343, 15 November 2021, Pages 63-72
International Journal of Cardiology

Non-cardiology vs. cardiology care of patients with heart failure and reduced ejection fraction is associated with lower use of guideline-based care and higher mortality: Observations from The Swedish Heart Failure Registry

https://doi.org/10.1016/j.ijcard.2021.09.013Get rights and content
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open access

Highlights

  • Approximately half of patients with HFrEF were treated in non-cardiology settings.

  • Non-cardiology care was associated with older age, lower education level, and lower use of beta-blockers and devices.

  • The risk of all-cause mortality was higher but the risk of first HF hospitalization lower in non-cardiology vs. cardiology care.

Abstract

Background

Patients with heart failure (HF) are often cared for by non-cardiologists. The implications are unknown.

Methods

In a nationwide HF cohort with reduced ejection fraction (HFrEF), we compared demographics, clinical characteristics, guideline-based therapy use and outcomes in non-cardiology vs. cardiology in-patient and out-patient care.

Results

Between 2000 and 2016, 36,076 patients with HFrEF were enrolled in the Swedish HF registry (19,337 [54%] in-patients overall), with 44% of in-patients and 45% of out-patients managed in non-cardiology settings. Predictors of treatment in non-cardiology were age > 75 years (adjusted odds ratio for non-cardiology 1.20; 95% confidence interval 1.14–1.27), lower education level (0.71; 0.66–0.76 for university vs. compulsory), valve disease (1.24; 1.18–1.31) and systolic blood pressure (SBP) >120 mmHg (1.05; 1.00–1.10). Non-cardiology care was significantly associated with lower use of beta-blockers (0.80; 0.74–0.86) and devices (intracardiac defibrillator [ICD] and/or cardiac resynchronization therapy [CRT]: 0.63; 0.56–0.71), and less frequent specialist follow-up (0.61; 0.57–0.65). Over 1-year follow-up the risk of all-cause mortality (adjusted hazard ratio 1.09; 1.03–1.15) was higher but the risk of first HF (re-) hospitalization was lower (0.93; 0.89–0.97) in non-cardiology vs. cardiology care.

Conclusions

In HFrEF, non-cardiology care was independently associated with older ageand lower education. After covariate adjustment, non-cardiology care was associated with lower use of beta-blockers and devices, higher mortality, and lower risk of HF hospitalization. Access to cardiology care may not be equitable and this may have implications for use of guideline-based care and outcomes.

Keywords

Quality of care
Primary care
Access to care
Treatment
Prognosis

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1

These authors contributed equally to the manuscript.