Consultation between specialists in Internal Medicine and Family Medicine improves management and prognosis of heart failure

Background and objectiveTo evaluate if consultation between specialists in Internal Medicine and family doctors (CIMFD) improves the clinical management and prognosis of patients with heart failure (HF).MethodsDesign: prospective case-control study (5 years of follow-up). Setting: community-based sample within the area of a university teaching hospital. Subjects: 1857 patients (>= 14 years) diagnosed for the first time with HF (1stDxHF), in the CIMFD. Control group: 1981 patients (from health centres not covered by the CIMFD), 1stDxHF, in the external consultations of the hospital. Main outcome measures: mortality rate (MR). Admissions (HA). Emergency services visits (ESV). Delays in receiving specialist attention (DRSA), and the resolution of the process (DRP). Number (NTP) and delays in reporting (DTP) tests performed. Proportion (PRC) and delay (DRC) in resolving cases.ResultsWe observed a reduction of: MR (by 10.8%, CI 95%, 8.6–13.0, p < 0.005); HA, per patient per year (ppy) (by 1.8, 1.3–2.3, p < 0.01); ESV, ppy (by 1.9, 1.2–2.6, p < 0.01); DRSA (by 26.5 days, 21.8–31.2, p < 0.001); DRP (by 21.0 days, 18.3–23.7, p < 0.001), and DRC (by 25.8 days, 20.3–31.4, p < 0.01). The PRC (17.2%, CI 95%, 15.5–18.9, p < 0.01) was higher for the CIMFD.ConclusionThe CIMFD approach improves prognosis and efficacy in the clinical management of patients with HF because it reduces mortality and morbidity (HA and ESV), shortens the delays in receiving care and in resolving the diagnostic and therapeutic process (DRSA, DRP, DRC), and increases the proportion of diagnosed and treated patients.