Disparities in the care and outcome of heart-failure patients admitted to internal medicine versus those admitted to cardiology department

Background: Heart failure (HF) is a major health concern. Admission of HF to cardiology department compared with admission to internal medicine department was associated with better outcomes. Given that the treatment for HF has evolved over the past decade, it is unknown if the association above still applies. We aimed to compare the demographic characteristics and clinical outcomes of HF patients admitted to the internal medicine departments with those admitted to cardiology departments.

Methods: An observational retrospective cohort study including patients admitted to Shamir Medical Center due to HF between the years 2007-2017. A comparison was made between the admitting departments (e.g. cardiology and internal medicine), and included patients’ baseline characteristics, clinical and laboratory indices with the primary outcome defined as 30-days readmission rate.

Results: included were 8,332 patients with a median age of 78 [69-85] years and majority of them (n=7,547;89.5%) were admitted to internal medicine departments. In comparison to those admitted to cardiology, patients admitted to internal medicine were older, had multiple comorbidities and a higher ejection fraction in echocardiography. Admission to the internal medicine departments was found to be an independent predictor for 30-days readmission and all-cause mortality rates (OR 0.79 95% CI [0.65-0.97]; HR 0.71 95% CI [0.65-0.79] respectively).

Conclusions: There is a significant difference between HF patients admitted to the internal medicine and cardiology departments. Due to the fact that most HF patients are admitted to internal medicine departments, further improvement of management should be a priority.