A recent study appearing in the Archives of Internal Medicine shows that the quality of management of heart failure in elderly patients in the US varies significantly depending on where patients live, what kind of doctor they are seeing, and what kind of hospital they are admitted to.
This study was conducted by examining the records of 30, 228 Medicare patients who survived hospitalizations due to heart failure. The quality of their care was evaluated by tabulating two simple measures that ought to be routinely done in virtually any patient admitted for heart failure: measurement of the ejection fraction, and prescribing ACE inhibitors. The investigators found that patients had significantly better quality of care if they received their care in Eastern states, if they received their care from a cardiologist (instead of from an internist or a family practitioner,) and if they were admitted to a hospital that was affiliated with a medical school or had cardiac catheterization facilities.
What this study means
Not all patients west of the Alleghenies or south of DC get poor care for heart failure. Not all internists are lousy at treating heart failure. And not all small community hospitals waste the lives of heart failure patients. There are plenty of good regions, doctors and hospitals all over the place.
However, the appropriate management of heart failure is MUCH more complex and difficult than it was only 5 or 10 years ago, and it seems that many, many doctors and hospitals just don't get it yet. This complexity is a good thing - it means a lot of recent advances have been made. The drug therapy of heart failure has advanced remarkably over the last decade, and the non-drug options for treating patients with difficult heart failure has progressed even more. In DrRich's opinion, patients with significant heart failure, to be treated entirely appropriately, ought to be followed not merely by a cardiologist, but by a cardiologist who has a special interest in heart failure and is truly keeping up with the advances. Heart failure is one condition where you can't afford to wait a year or two for the data to "filter down" to your doctor.
At least make sure your doc is meeting the bare minimal standards - standards like those evaluated in this study. Virtually any patient with heart failure ought to be able to ask their doctor what their ejection fraction is and get an immediate answer, and ought to have been tried on an ACE inhibitor. If your doc hasn't taken even these simple and basic steps, odds are high he/she is missing a lot of important features in the appropriate management of heart failure.
