Resource Use and Survival of Patients Hospitalized with Congestive Heart Failure: Differences in Care by Specialty of the Attending Physician

Article Abstract:

Treatment of congestive heart failure by cardiologists may be more expensive and no more effective than treatment by a general practitioner. This was the conclusion of a study of 1,298 patients hospitalized for congestive heart failure who were treated by a generalist or a cardiologist. Compared to generalists, cardiologists ordered more tests and treatment costs were 43% higher. Short-term survival rates were similar in both groups, however, at one year, patients of cardiologists had slightly better survival rates. This could be due to the fact that they were younger and not as sick as the other patients.

Analysis, Evaluation, Congestive heart failure, Cardiologists, Medical care, Cost of, Health care costs

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The SUPPORT prognostic model: objective estimates of survival for seriously ill hospitalized adults

Article Abstract:

A survival model for seriously ill hospitalized patients may be as accurate as physicians' prognoses. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) model was developed based on data from 4,301 patients at five medical centers. Researchers studied patients with nine diagnoses such as lung cancer, liver disease or congestive heart failure, who were expected to have a six-month mortality rate of 50%. Variables used in the model included age, neurologic function, vital signs, common laboratory measures, and physiological signs specific to diagnoses. Physicians gave their estimates for each patient's chances of two- and six-month survival within six days of hospitalization. The SUPPORT model predictions were valid, and may be especially accurate when combined with physicians' clinical judgment. Seriously ill patients often want to know the probability of their survival, and such estimates can be useful in making treatment decisions.

Models, Prognosis

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Patient Age and Decisions To Withhold Life-Sustaining Treatments from Seriously Ill, Hospitalized Adults

Article Abstract:

Life-sustaining treatment is more likely to be withheld from older terminally ill patients. Researchers evaluated the progress of care for 9,105 patients with a 50% likelihood of dying within six months. For each decade of older age, the rate of withholding surgery, dialysis, or ventilator support increased 12-19%. Physicians tended to underestimate the desire of older patients to continue life-sustaining treatment.

United States, Health aspects, Aged, Elderly, Terminal care, Life support systems (Critical care), Life support care

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