The effect of management of older patients with heart failure by general physicians on mortality and hospitalization rates: a retrospective cohort study.

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Kasumi Nishikawa, Ryuichi Ohta, Chiaki Sano
{"title":"The effect of management of older patients with heart failure by general physicians on mortality and hospitalization rates: a retrospective cohort study.","authors":"Kasumi Nishikawa, Ryuichi Ohta, Chiaki Sano","doi":"10.1186/s12875-024-02558-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates.</p><p><strong>Methods: </strong>This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors.</p><p><strong>Results: </strong>A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio [OR], 0.62) and hospitalization (OR, 0.73).</p><p><strong>Conclusions: </strong>In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities.</p>","PeriodicalId":72428,"journal":{"name":"BMC primary care","volume":"25 1","pages":"330"},"PeriodicalIF":2.0000,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11378556/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC primary care","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s12875-024-02558-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0

Abstract

Background: The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates.

Methods: This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors.

Results: A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio [OR], 0.62) and hospitalization (OR, 0.73).

Conclusions: In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities.

全科医生对老年心力衰竭患者的管理对死亡率和住院率的影响:一项回顾性队列研究。
背景:由于人口老龄化,心力衰竭的发病率越来越高,导致医疗费用不断增加,同时患有多种疾病的患者也越来越多。除内科医生(如心脏病专家)外,全科医生对心力衰竭的最佳管理也至关重要,但具体情况尚不清楚。在这项研究中,我们旨在确定由全科医生管理的老年心衰患者与由内科医生管理的老年心衰患者在治疗效果上的差异,尤其是在住院率和死亡率方面:这是一项回顾性队列研究,研究对象是在日本一家社区医院就诊的心衰患者。从 2015 年 9 月至 2023 年 8 月的 9 年间,根据电子病历数据中的国际疾病分类代码筛选出心衰患者。自变量为是否由全科医生治疗患者;主要结果为死亡;次要结果为住院治疗;协变量为患者背景,包括合并症。在对混杂因素进行调整后,采用多元逻辑回归分析评估由全科医生治疗与死亡和住院之间的关系:共发现了 1032 名心衰患者,平均年龄为 82.4 岁,48.9% 为男性。与内科医生治疗的患者相比,全科医生治疗的患者年龄更大,更有可能患有痴呆症,也更有可能需要护理。由全科医生治疗与死亡(几率比 [OR],0.62)和住院(OR,0.73)呈显著负相关:结论:在医疗专业日益分化的日本,由全科医生对患有心力衰竭和多种并发症的老年患者进行综合治疗可降低住院率和死亡率。对全科医生进行适当的教育并增加他们的人数,可能对成功治疗老龄化社区的心衰患者至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.40
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信