An electronic consultation programme impacts on heart failure patients prognosis: implications for heart failure care

Abstract

Abstract Background Multidisciplinary care plans that comprise professionals from different levels of care optimize the diagnosis and treatment of patients with heart failure (HF). Purpose Our objective was to analyse the clinical characteristics, 1 year prognosis and the prognostic determinants of patients with a previous diagnosis of HF, categorized by their previous HF-related hospitalization status (<1year or >1 year before or never hospitalized), referred by general practitioners (GPs) to a cardiology department (CD) by an e-consultation. Methods Data were obtained from 4851 HF patients referred by GPs to the cardiology department for an e-consultation from 2013 to 2020. We analysed the clinical characteristics of HF patient. We studied the whole cohort, and then subdivided it into three groups of diagnosis: patients who had never been hospitalized due to HF, patients with a recent HF-related hospitalization (<1 year), and patients with a remote HF-related hospitalization (≥1 year). To assess 1 year prognosis after e-consultation, we analysed the following health outcomes: HF-related hospitalizations, cardiovascular hospitalizations, HF-related mortality, cardiovascular mortality and all-cause mortality (Fig. 1). Qualitative variables are expressed as percentages (%), and quantitative continuous variables as means (standard deviation), or medians (interquartile range) if the distribution was asymmetric. To verify differences between groups, χ2 was used for quantitative variables, and ANOVA for qualitative variables. Results The delay of time to e-consults were solved was 8.6 + 8.6 days with 84.3% solved in <14 days. For the 1 year prognosis evaluation after the e-consult were assessed the cardiovascular hospitalizations, HF-related hospitalizations, HF-related mortality, cardiovascular mortality, and all-cause mortality. Compared with the group without a previous hospitalization, patients with recent and remote HF hospitalization were at higher risk of a new HF-related hospitalization (OR: 19.41 [95% CI: 12.95–29.11]; OR: 8.44 [95% CI: 5.14–13.87], respectively) (Fig 2), HF-related mortality (OR: 2.47 [95% CI: 1.43–4.27]; OR: 1.25 [95% CI: 0.51–3.06], respectively), as well as cardiovascular hospitalizations and mortality and all-cause mortality. Reduction in the time elapsed because e-consultation was solved was associated with lower risk of HF-related mortality (OR: 0.94 [95% CI: 0.89–0.99]), cardiovascular mortality (OR: 0.96 [95% CI: 0.93–0.98]), and all-cause mortality (OR: 0.98 [95% CI: 0.97–1.00]). Conclusions A clinician-to-clinician e-consultation programme between GPs and cardiologists in patients with HF allows to solve the demand of care in around 25% e-consults without an in-person consultation; the patients with a previous history of HF-related hospitalization showed a worse 1 year outcome. A reduction in the time elapsed because e-consultation was solved was associated with a mortality reduction.