CONGESTED HEART FAILURE TREATMENT

Congested Heart Failure treatment



Congested Heart Failure treatment

Introduction

Congestive heart failure (CHF) is a major public health problem that affects more than 2 million people and causes 200,000 deaths annually in the United States. Currently, CHF is the leading diagnosis-related group (DRG) discharge diagnosis in the U.S., representing nearly 1 million hospitalizations per year, an estimated annual cost of more than $ 7 billion. Therefore, CHF has become a target for cost reductions in areas with high penetrance of managed care(Lewis, 2006).

Research problem and purpose

Treatment of patients with heart failure is not the sole responsibility of the cardiologist. Indeed, in academic medical centers and community hospitals, care for patients with CHF can be exclusively provided by primary care physicians, despite published recommendations suggesting the role of the cardiologist. However, the value of a specialist in caring for large numbers of patients with CHF has not been assessed. Thus, we studied the clinical characteristics and courses of consecutive patients admitted to the university teaching hospital with a primary diagnosis of CHF discharge. To determine differences in the structure of physician practice, we compared the results of treatment and patients admitted to hospital with CHF treated by wide and those whose care was guided by a cardiologist(Kennedy-Malone, 2007).

Review of literature

In recent years, clinical practice suggest that CHF should be aggressively managed in an outpatient setting, and that hospitalization should be reserved for those who are newly diagnosed with moderate to severe heart failure, recurrent CHF complicated by acute threatening events or clinical situations or decompensated chronic CHF. These guidelines also suggest that a thorough diagnostic evaluation should be performed in all patients with heart failure to identify etiologic factors, prognosis and guide therapy(Kannel, 2006). In addition, the guidelines emphasize the importance of curative measures, which have been demonstrated to improve survival in patients with CHF.

Research design

We studied 328 patients discharged from the University of Pittsburgh Medical Center from January 1 to September 30, 1995, with a primary diagnosis of CHF discharge DRG.

Sampling

Thirty patients were excluded from the study because they had previously orthotopic heart transplantation (N = 11) or not treated with wide or cardiologists (N = 19). The remaining 298 patients were divided into two groups: the broad "patients (n = 160) were cared for exclusively practicing family physician or a cardiologist and patients (n = 138) were cared for full-time cardiologist only university or in combination ...