Delay in cardiology consultation after primary care physician referrals in heart failure: Clinical implications.

Abstract

To investigate the association between the elapsed time to cardiology care following a primary care physician (PCP) referral and 1year outcomes among patients with heart failure (HF). Data from electronic medical records at our institution encompassing all PCP referrals to cardiology consultation from 2010 to 2021 (N=68518) were analysed. Of these, 6379 patients had a prior diagnosis of HF. Using a Cox regression model for hospitalization and mortality outcomes, the association between delay time in cardiology care post-PCP referral and 1year outcomes was examined, adjusting for age, gender and comorbidities. A significant increase in 1year mortality rates with delayed cardiology care was observed for each day: all-cause (0.25%), cardiovascular (CV) (0.13%) and HF (0.11%). In multivariate analysis, continuous delay to consultation was independently associated with higher risk of all-cause [hazard ratio (HR): 1.02; 95% confidence interval (CI) (1.01-1.02); P<0.01], CV [1.01 (1.00-1.02); P<0.01] and HF mortality (HR: 1.01; 95% CI 1.00-1.03; P<0.01). Patients attended in the 25th quartile of time delay (<2days) had significantly lower mortality and HF readmission rates [1.21 (1.10-1.33); P<0.01] as compared with patients in the 75th quartile (>14days). Delay in cardiology assistance following a PCP referral among patients previously diagnosed with HF was associated with increased in all-cause, CV, and HF mortality at 1year.