Ongoing specialist care can improve heart attack survival

When a good network of care involving access to specialists and family physicians is established, it can significantly improve the number of lives saved from heart disease, especially in rural areas, according to a University of Alberta two-year study.

Dr. Paul Armstrong, professor of medicine in the University of Alberta's division of cardiology, and one of the study's authors, says more ways are needed to improve timely and appropriate access to specialists and to improve the structuring of collaborative care.

It was found that patients discharged after their first hospital stay for heart failure had far better outcomes if they received regular cardiovascular follow-up visits with a physician, and 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. They found that patients who were elderly and living in rural areas had less access to specialty care.

It is now clear 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 are more often than not located in specialty academic centres, and difficult for rural patients to access, said Dr. Armstrong.

The 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. Compared with patients who received no follow-up care, patients who received regular cardiovascular follow-ups with a specialist had 38 per cent fewer visits to the emergency room, only 13 per cent were readmitted to hospital and the one-year mortality rate was lower--22 per cent versus 37 per cent.

Dr. Armstrong says patients who have follow-up care from both specialists and family physicians are in better health because they have more contacts with the medical community. Deterioration in status can be more easily detected, medications adjusted, therapies reinforced. Congestive heart failure is suffered by up to two per cent of North American adults, and despite advances in treatment and therapy, still holds a poor prognosis; 30 to 50 per cent die within a year.

Results from the two-year study, which also included research from the University of Ottawa, were published recently in the Canadian Medical Association Journal.