{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:08:48Z","timestamp":1790816928673,"version":"4.1.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2010,11,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>The type of outpatient physician care after an emergency department visit for heart failure may affect patients' outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      Using the National Ambulatory Care Reporting System, we examined the care and outcomes of heart failure patients who visited and were discharged from the emergency department in Ontario, Canada (April 2004 to March 2007). Early collaborative care by a cardiologist and primary care (PC) physician within 30 days after discharge was compared with PC alone. Care for 10 599 patients (age, 74.9\u00b111.9 years; 50.2% male) was provided by PC alone (n=6596), cardiologist alone (n=535), or concurrently by both cardiologist and PC (n=1478); 1990 did not visit a physician. Collaborative care patients were more likely to undergo assessment of left ventricular function (57.4% versus 28.7%), noninvasive stress testing (20.1% versus 7.8%), and cardiac catheterization (11.6% versus 2.7%) compared with PC. Drug prescriptions (patients \u226565 years of age) demonstrated higher use of angiotensin-converting enzyme inhibitors (58.8% versus 54.6%), angiotensin receptor blockers (22.7% versus 18.1%), \u03b2-adrenoceptor antagonists (63.4% versus 48.0%), loop diuretics (84.2% versus 79.6%), metolazone (4.8% versus 3.4%), and spironolactone (19.8% versus 12.7%) within 100 days after emergency department discharge for collaborative care compared with PC. In a propensity-matched model, mortality was lower with PC compared with no physician visit (hazard ratio, 0.75; 95% confidence interval, 0.64 to 0.87;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Collaborative care reduced mortality compared with PC (hazard ratio, 0.79; 95% confidence interval, 0.63 to 1.00;\n                      <jats:italic>P<\/jats:italic>\n                      =0.045). Sole cardiology care conferred a trend to increased mortality (hazard ratio, 1.41 versus collaborative care; 95% confidence interval, 0.98 to 2.03;\n                      <jats:italic>P<\/jats:italic>\n                      =0.067).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>Early collaborative heart failure care was associated with increased use of drug therapies and cardiovascular diagnostic tests and better outcomes compared with PC alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.110.940262","type":"journal-article","created":{"date-parts":[[2010,10,18]],"date-time":"2010-10-18T22:04:18Z","timestamp":1287439458000},"page":"1806-1814","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":166,"title":["Improved Outcomes With Early Collaborative Care of Ambulatory Heart Failure Patients Discharged From the Emergency Department"],"prefix":"10.1161","volume":"122","author":[{"given":"Douglas S.","family":"Lee","sequence":"first","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Th\u00e9r\u00e8se A.","family":"Stukel","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Austin","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Alter","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Schull","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"You","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Chong","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Henry","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack V.","family":"Tu","sequence":"additional","affiliation":[{"name":"From the Institute for Clinical Evaluative Sciences (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., J.J.Y., A.C., D.H., J.V.T.), Toronto General Hospital and University Health Network (D.S.L.), Dalla Lana School of Public Health (T.A.S., P.C.A., J.V.T.), Sunnybrook Health Sciences Centre (M.J.S., J.V.T.), Hamilton General Hospital, McMaster University (J.J.Y.), and University of Toronto (D.S.L., T.A.S., P.C.A., D.A.A., M.J.S., A.C., D.H., J.V.T.), Toronto, Ontario, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.88.1.107"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.191261"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.1999.00520.x"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.07.064"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.11.1197"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa020080"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1032017"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2004.04.006"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2003.07.005"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2007.07.007"},{"key":"e_1_3_3_12_2","volume-title":"Physicians in Ontario 2008","author":"Ontario Physician Human Resources Data Centre (OPHRDC)","year":"2009","unstructured":"Ontario Physician Human Resources Data Centre (OPHRDC). Physicians in Ontario 2008. Toronto, Ontario, Canada: McMaster University; 2009."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.109.192065"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.11.1358"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0828-282X(06)70237-9"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2008.08.026"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2580"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.105.611194"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/circoutcomes.108.802686"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.12.1494"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-200502000-00012"},{"key":"e_1_3_3_22_2","first-page":"1","article-title":"National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary","volume":"7","author":"Pitts SR","year":"2008","unstructured":"Pitts SR, Niska RW, Xu J, Burt CW. National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. Natl Health Stat Report. 2008;7:1\u201338.","journal-title":"Natl Health Stat Report"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02493-2"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2004.04.013"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2001.118473"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.116.2.346"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.696906"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/circheartfailure.109.885285"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(99)70006-2"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(99)70253-X"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.4.431"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2004.08.013"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1525-1497.1997.07105.x"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00176-9"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.110.940262","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T01:45:56Z","timestamp":1715564756000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.110.940262"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010,11,2]]},"references-count":33,"journal-issue":{"issue":"18","published-print":{"date-parts":[[2010,11,2]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.110.940262"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.110.940262","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.5728956.5711055","asserted-by":"object"}]},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010,11,2]]},"assertion":[{"value":"2010-01-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2010-08-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2010-10-18","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}