Elapsed time to cardiology consultation after a primary care physician referral and major outcomes in patients with heart failure. Influence of the ischemic aetiology

Background

Heart Failure (HF) is a clinical condition characterized by frequent episodes of decompensation with an increasing risk of hospitalization and mortality particularly in the ischemic aetiology. Early identification and management of worsening episodes is needed for maintain the clinical stabilization; however, the impact of delayed cardiology care in each sex after referral by a Primary Care Physician (PCP) is unknown. The aim of our study is to investigate the association between the elapsed time to cardiology care following a PCP referral and one-year outcomes among patients with HF, according the ischemic and non-ischemic aetiology.

Methods

Data from electronic medical records at our institution encompassing all PCP referrals to cardiology consultation from 2010 to 2024 of patients with previous diagnosis of HF (N = 7,243; 5,795 patients with ischemic HF and 1,448 patients with Non-ischemic aetiology) were analysed. The ischemic aetiology was defined when a previous myocardial infarction (MI) event was documented. For the mortality analysis, Cox proportional hazards models (hazard ratios, HR) were used. For the analysis of recurrent hospitalizations, negative binomial regression models (incidence rate ratios, IRRs) were used, incorporating the logarithm of follow-up time as an offset. All models were adjusted for age, sex, and history of ischemic heart disease (MI).

Results

Delay time was associated with a worse prognosis in the overall HF population. In the multivariate analysis, each additional day of delay was associated with a significant increase in all-cause mortality (HR [95%CI]: 1.01 [1.01–1.02], p < 0.001), cardiovascular mortality (HR [95%CI]: 1.01 [1.00–1.02], p = 0.027), and heart failure mortality (HR [95%CI]: 1.02 [1.01–1.04], p = 0.006). Regarding hospitalizations, no increase was observed in those due to heart failure (IRR [95% CI]: 0.999 [0.996–1.002], p = 0.452); however, the risk of hospitalizations for any cause (IRR [95% CI]: 1.00 [1.00–1.01], p = 0.007) and for cardiovascular events (IRR [95% CI]: 1.00 [1.00–1.01], p = 0.008) was increased. No significant interaction was found between delay and the ischemic aetiology, prior myocardial infarction, for any of the outcomes (p > 0.05), indicating that the risk pattern associated with the elapsed time to cardiology consultation after a PCP referral waiting is independent of ischemic aetiology.

Conclusions

Delays in cardiology care after a PCP referral for in patients with heart failure are associated with a worse prognosis in terms of mortality and hospitalizations risks. The association between increased cardiology consultation delay and 1-year outcomes was independent of the HF ischemic aetiology.

Figure. All-cause Mortality rate according to delay time (days) in the assistance of patients referred to Cardiology Department with previous heart failure.Figure