Background A clinician-to-clinician electronic consultation (e-consultation) programme may not only improve the accessibility to care but may also impact patient outcomes, particularly in heart failure (HF) patients with a previous episode of hospitalization (HFH), group of patients associated with a worse outcome. Purpose To evaluate the impact of an outpatient care management programme that includes a clinician-to-clinician e-consultation on delay time in care, hospital admissions, and mortality in a high-risk group of patients with heart failure (HF) and previous episodes of HF hospitalization (HFH). Materials and methods We selected 6444 HF patients who visited the cardiology service at least once between 2010 and 2021. Of these, 4146 were attended in e-consultation, and 2230 had previous HFH (Fig 1a). Using an interrupted time series regression model, we analysed the impact of incorporating e-consultation into the healthcare model in the group of patients with HFH and evaluated the elapsed time to cardiology care, HF, cardiovascular (CV), and all-cause hospital admissions and mortality, calculating the incidence relative risk (iRR). We performed a multivariate logistic regression for each of these outcomes in both groups. Results Patients with HFH had a higher prevalence of men (P < 0.001) but had a similar age (P = 0.267) compared to patients without HFH. Patients with HFH had a higher prevalence of diabetes (P < 0.001), ischaemic heart disease (P = 0.036), and peripheral arterial disease (P = 0.008) (Fig 1b). In the group of patients with HFH, the introduction of e-consult substantially decreased waiting times to cardiology care (8.6 [8.7] vs. 55.4 [79.9] days, P < 0.001) (Fig 2a). In that group of patients, after e-consult implantation, hospital admissions for HF were reduced (iRR [95%CI]: 0.837 [0.840–0.833]), 0.900 [0.862–0.949] for CV and 0.699 [0.678–0.726] for all-cause hospitalizations (Fig 2b). There was also lower mortality (iRR [95%CI]: 0.715 [0.657–0.798] due to HF, 0.737 [0.764–0.706] for CV and 0.687 [0.652–0.718] for all-cause) (Fig 2c). The improved outcomes after e-consultation implementation were significantly higher in the group of patients with previous HFH. The multivariate analyses showed a higher risk of hospitalizations in men, patients with HFH, and those who required more emergency department assistance (Fig 2d). Conclusions In patients with HFH, an outpatient care programme that includes an e-consultation significantly reduced waiting times to cardiology care and was safe, with a lower rate of hospital admissions and mortality in the first year. Our results may have implications for optimize the heart failure care organization.Figure 1Figure 2

中文翻译：

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临床医生对临床医生电子会诊计划对既往住院心力衰竭患者的影响。对心力衰竭多学科管理的意义


背景 临床医生对临床医生的电子咨询 （e-consultation） 计划不仅可以提高获得护理的机会，还可能影响患者的预后，特别是对于既往有住院治疗 （HFH） 发作史的心力衰竭 （HF） 患者，这组患者与结局更差相关。目的 评估门诊护理管理计划（包括临床医生对临床医生的在线咨询）对心力衰竭 （HF） 和既往 HF 住院 （HFH） 高危患者群体护理延迟时间、住院和死亡率的影响。材料和方法 我们选择了 6444 例在 2010 年至 2021 年期间至少就诊过一次心脏病学服务的 HF 患者。其中，4146 人通过电子会诊就诊，2230 人既往患有 HFH（图 1a）。使用中断时间序列回归模型，我们分析了将电子咨询纳入 HFH 患者组医疗保健模型的影响，并评估了心脏病学护理、HF、心血管 （CV） 以及全因住院和死亡率的经过时间，计算发生率相对风险 （iRR）。我们对两组的这些结局中的每一个都进行了多变量 logistic 回归。结果 与无 HFH 患者相比，HFH 患者的男性患病率较高 （P < 0.001），但年龄相似 （P = 0.267）。HFH 患者患糖尿病 （P < 0.001）、缺血性心脏病 （P = 0.036） 和外周动脉疾病 （P = 0.008） 的患病率较高 （图 1b）。在 HFH 患者组中，电子会诊的引入大大减少了心脏病护理的等待时间 （8.6 [8.7] vs. 55.4 [79.9] 天，P < 0.001）（图 2a）。 在该组患者中，植入 e-consult 后，HF 住院率降低 （iRR [95%CI]： 0.837 [0.840–0.833]），CV 减少 0.900 [0.862–0.949] 和全因住院 0.699 [0.678–0.726] （图 2b）。死亡率也较低（iRR [95%CI]：HF 为 0.715 [0.657–0.798]，CV 为 0.737 [0.764–0.706]，全因为 0.687 [0.652–0.718]）（图 2c）。在既往 HFH 患者组中，实施电子会诊后结局的改善显著更高。多变量分析显示，男性、HFH 患者和需要更多急诊科帮助的患者住院风险更高（图 2d）。结论 在 HFH 患者中，包括电子会诊在内的门诊护理计划显著缩短了心脏病护理的等待时间，并且是安全的，第一年的住院率和死亡率较低。我们的结果可能对优化心力衰竭护理组织具有意义。图 1图 2