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Heart failure patients have better outcomes when treated at larger community or teaching hospitals: study

August 15

Dr. Sacha BhatiaHeart failure patients who are discharged from small hospitals with a lack of associated specialty care are more likely to be readmitted to hospital, revisit the emergency department, and less likely to receive high quality care after discharge, according to a new study by researchers at Women’s College Hospital, the Peter Munk Cardiac Centre, and the Institute for Clinical Evaluative Sciences (ICES).

The study, published recently in the British Medical Journal Quality and Safety, sheds light on possible factors behind high heart failure readmission and emergency department visit rates in Canadian hospitals, a significant burden on the healthcare system.

“Each year, approximately 100,000 Canadians visit the emergency department for heart failure,” said Dr. Sacha Bhatia, lead author of the study and a cardiologist at Women’s College Hospital. “While many studies have focused on heart failure readmission rates, the novel aspect of our study was the examination of system factors that may contribute to high readmission rates and what can be done to improve a patient’s quality of care.”

In the study, the researchers analyzed data from more than 89,000 patients who visited an emergency department in Ontario between April 1, 2004 and March 2010. The researchers found heart failure patients, treated at smaller hospitals with the lowest rates of admission for these types of patients, were more likely to:

  • Return to the emergency department for care
  • Be hospitalized for heart failure within 30 days
  • Be hospitalized for cardiovascular disease within 30 days
  • Have inadequate post-discharge follow-up from cardiac specialists with or without family doctors.

“The study tells us that hospital characteristics explain some of the differences in varying admission rates and outcomes for patients with heart failure” explained Dr. Douglas Lee, senior author and scientist at ICES. “Higher rates of repeat hospital visits and admissions occurred more often with smaller hospital size, where there is reduced access to specialist care both in the hospital and the community.”

More immediate access to rapid cardiovascular care after emergency department discharge along with improved guidelines for physicians are critical to help patients manage their condition and reduce hospital visits, he added.

“Doctors need improved tools to help better identify low and high risk patients so they can determine if they need to be in hospital or can recover at home,” Dr. Bhatia noted. “This will help reduce variations in admission rates across the province and improve treatment options and outcomes for patients.”

 

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