More on who manages CHF best: PCPs vs. specialists
More on who manages CHF best: PCPs vs. specialists
Last month, CHF Disease Management featured a series of articles about whether CHF patients fare better under the care of cardiologists or of primary care physicians (PCPs). The lead author of a study exploring the question, Edward F. Philbin, MD, in the section of heart failure and cardiac transplantation at Henry Ford Hospital in Detroit says that for the heart failure patient with comorbidities, the best way to go is probably a PCP with a cardiologist consult. "There’s value in teamwork and continuity of care," says Philbin.
Randall Williams, MD, a cardiologist at a specialized CHF program at Evanston (IL) Hospital, agrees and says that the CHF subspecialist’s scope of expertise is related to CHF, not diabetes, kidney problems, or asthma. In those scenarios, patients benefit from care by their PCPs who continue to be involved in their ongoing management.
This month, CM probes further by looking at two clinical trials published in the wake of Philbin’s study. One evaluates specialized outpatient care by clinics devoted to CHF treatment. Several studies have reported improved outcomes when patients are managed by specialized CHF clinics, but it is uncertain whether this improvement reflects differences in physician practices or other aspects of the operation of these clinics. The second trial presented here compares the care administered by heart failure specialists to that given by general cardiologists.
William T. Abraham, MD, associate professor of medicine and director of the section of heart failure and cardiac transplantation at the University of Cincinnati, says there are 5 million heart failure patients in this country and only about 9,000 practicing cardiologists. "There will never be enough of us to reach the tens of thousands of heart failure patients in our own local areas." says Abraham, a cardiologist-CHF subspecialist. He stresses the importance of thinking about nurse practitioners, family practitioners, and internists as heart failure specialists. "If we cannot teach them how to take care of heart failure, if we cannot disseminate a model like ours to the community, we’ll help a few patients, but we’ll never be able to help the vast majority."
And the task may continue to become more complicated as it becomes more difficult for the family physician and even the general cardiologist to be a CHF expert.
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