November 21, 1997

Specialist care better for heart failure patients: study

Specialist care better for heart failure patients: study

Patients with severe heart failure fared far better in the care of heart failure specialists than primary care physicians, Vanderbilt University Medical Center researchers have found.

Their findings were reported earlier this month in the American Heart Association journal Circulation.

The study has important implications in the search for the best and most cost-effective treatment for the growing problem of heart failure, said Dr. John R. Wilson, professor of Medicine and director of VUMC's Heart Failure and Transplant Program.

"This study found that patients with severe heart failure do better under the care of heart failure specialists, compared to internists, general practice physicians or even general cardiologists who do not specialize in heart failure," said Wilson, one of the authors of the paper.

"This is one of several studies that have made this point. The next step needs to be to make sure the insurance companies understand that not only do patients do better, but the treatments cost less."

Heart failure is a dramatically escalating problem in the United States as the population gets older and as advanced treatments enable more people to survive heart attacks. In 1970, 250,000 Americans were diagnosed with heart failure; that number had climbed to nearly 700,000 by 1992.

The VUMC researchers examined rates of hospitalization, medication use and peak exercise capacity among 134 patients referred to VUMC's Heart Failure and Transplant Program between July 1994 and June 1995. The study included 39 women and 95 men, with an average age of 52.

They found that individuals required hospitalization less frequently and had fewer symptoms, such as shortness of breath, when their care was transferred to heart failure specialists.

During the year before referral to specialists, 94 percent of the patients in the study had been hospitalized. That dropped to 44 percent during the year after referral, the researchers reported.

In addition, the 88 patients who were able to exercise on a treadmill at the time of referral significantly increased their exercise ability, the study found.

The improved results may be due in part to more aggressive therapy with diuretics and more appropriate use of other medications such as beta-blockers and anti-arrhythmic drugs, the researchers said.

In an accompanying editorial, Drs. William T. Abraham and Michael R. Bristow of the University of Colorado noted that, currently, 83 percent of patients with heart failure are not cared for by specialists.

"Specialized heart failure centers offer complex, cost-effective treatments not available in other settings," they wrote, including heart transplantation, other heart surgeries and investigational medical treatments.

Co-authors of the study included Dr. Javed Butler, a fellow in Cardiology; Dr. Don B. Chomsky, assistant professor of Medicine; Dr. Stacy F. Davis, assistant professor of Medicine; and Dr. Sai Hanumanthu, a resident in Cardiology.