Consistent Care By One Physician Is Associated With Fewer Cardiovascular Hospitalizations Amongst Patients With Heart Failure

Abstract

Introduction

Strong patient-physician relationships may optimize care in heart failure (HF). Provider consistency is thought to be important for these relationships and potentially allowing for better patient outcomes. As more practices move towards group models, the impact of care provided by a consistent physician on outcomes in HF remains unexplored.

Hypothesis

We hypothesized that care provided by a consistent physician would be linked to improved outcomes among patients with HF as measured by cardiovascular (CV) hospitalizations and mortality.

Methods

We retrospectively studied patients with HF treated in an urban health-system from 2015 to 2022. HF was identified upon meeting all 3 of the following criteria: ICD code for HF, prior CV hospitalization, and elevated natriuretic peptide (BNP >100, NTproBNP >400) in the preceding year. We also examined whether patient-physician sex concordance, defined as having consistent care for 75% of visits with a physician of the same sex was associated with outcomes. Varying frequencies were used to define consistency and sex concordance (67%, 75% and 85%) to better assess their relationship with outcomes. We conducted univariate and multivariate Poisson regression analyses on the association of consistent care with CV hospitalizations and mortality.

Results

A total of 1848 patients met inclusion criteria, with mean age 71.1 ± 14.5, 40% female, and mean follow up time of 620 days. Consistency criteria was met by 1466 (79.3%) patients. Patients without consistency were younger (p<0.001), with more kidney disease (p<0.001), diabetes (p=0.001), and obesity (p=0.002), and more clinic visits on average (9.4 vs 6.8, p<0.001). Physician consistency was associated with significantly fewer CV hospitalizations (Incidence Rate Ratio (IRR) 0.734 [95% CI, 0.688-0.783], p<0.001), after adjusting for age, sex, race, and comorbidities (Fig1). The results were similar with consistency defined as 67% (IRR 0.735 [95% CI, 0.688-0.786], p<0.001), and 85% (IRR 0.733 [95% CI, 0.690-0.778],p<0.001). There was no significant association between consistent care and mortality (p=0.875). Further, we observed that patient-physician sex concordance amongst patients with 75% consistency was also associated with fewer CV hospitalizations (IRR 0.844 [95% CI, 0.797-0.895], p<0.001) but not mortality (HR 1.08; 95%CI 0.889-1.316).

Conclusions

Among outpatients with HF, receiving care from a consistent physician was associated with fewer CV hospitalizations but not mortality, strengthened by patient-physician sex concordance. Prospective studies are needed to verify these findings and assess how they may play a role in optimizing care delivery in HF.