Continuity of primary care and its impact on prognosis in patients with heart failure referred for cardiology consultation

To assess the prognostic impact of continuity of care (COC), defined as care provided by the same primary care physician (PCP), in patients with heart failure (HF) referred for cardiology consultation. We analyzed all patients with previous HF referred by PCPs between January 2010 and December 2023, in our healthcare area (Santiago de Compostela, Galician-Spain). COC was analyzed by considering whether the referring PCP was the patient’s assigned PCP (PCP stability) or COC interrupted. To estimate the association between COC and hospitalization and mortality outcomes (all-cause, cardiovascular, and HF), we used Cox regression to obtain hazard ratio (HR) and 95% confidence interval (95% CI), adjusting for potential confounders. 5,899 patients’ referrals were included. Patients with COC interrupted had a higher annual referral rate (2.4 [3.0] vs. 1.5 [0.5], p < 0.001). Patients with PCP stability had a lower risk of all-cause hospitalizations (HR [95% CI]: 0.85 [0.76–0.95], p = 0.006) and all-cause mortality (HR [95% CI]: 0.89 [0.80-1.00], p = 0.044). The COC interrupted was associated with higher risk of mortality for CV causes (HR [95%CI]: 2,65 [2,02–3,48]) and HF causes (HR [95%CI]: 1,66 [1,94 − 1,42]), and also hospitalizations for CV causes (HR [95%CI]: 1,64 [1,27 − 2,12]) and HF causes (HR [95%CI]: 1,78 [1,19 − 2,65]). The COC, defined as care provided by the same PCP, for a group of patients with HF, reduced the number of referrals and was associated with better outcomes, including lower rates of all-cause hospitalizations and mortality. The COC interruption was associated with worst prognosis at 1-year.