Characteristics of inpatients with heart failure selected for cardiologist-directed care at North Shore Hospital

Abstract

Background: Waitemata DHB provides comprehensive cardiology inpatient services, with 35 dedicated beds, and 24/7 ward consultation at two acute hospitals. Patients admitted with congestive heart failure (CHF) are cared for by both Cardiology and General Medicine. Cardiologists select patients for admission to the cardiology beds. We investigated differences in the patients selected by Cardiology and those managed by General Medicine at North Shore Hospital. Methods:Audit of admissions in 2013 identified 46 patients with a primary diagnosis of CHF (DRGs = ‘CHF’, ‘left ventricular failure’ or ‘cardiomyopathy’) admittedunderCardiology. We randomly selected 46 out of 748 CHF patients admitted under General Medicine in 2013 as a comparison group. Results: Cardiology patients were more likely to be male (87% vs 43%), younger (<70 years = 64% vs 11%), Maori (20% vs 4%), and have severe systolic dysfunction: EF% <35% = 63% vs 36%. HFPEF was more common in General Medicine patients (3% vs 38%). Myocardial infarction (26% vs 4%) and valvular disease (26% vs 17%) were more common in Cardiology patients. Cardiology patients had far greater outpatient follow-up (72% vs 16%), and lower readmission rates (22% vs 59%). All-cause mortality at 12 months was high in the General Medicine group (15% vs 48%). Conclusion: There are significant clinical differences in patients selected for cardiologist-directed inpatient care. Further work is needed to assess whether this is the best use of specialist resources, and whether there are opportunities for improvement in the care of CHF patients remaining under the General Medicine service.