To the Editor: The study of the relationship between early physician follow-up and 30-day readmission among older patients with heart failure by Dr Hernandez and colleagues1 was timely and important. However, I was disappointed only cardiologists and general internists were listed as postdischarge physicians, and that the conclusion called for increased use of nurse practitioners and physician assistants. Absent was a discussion of the role of the family physician.
In 2000 to 2003, family physicians conducted 24% of all outpatient visits compared with 16% for general internists.2 In patients treated in New York state in 1995, the mortality and hospital readmission rates for heart failure did not differ among cardiologists, general internists, and family physicians.3 In British Columbia, the cost to the health care system for an elderly patient with heart failure but without a family physician was estimated to be 2.5 times greater than for those patients who are cared for by a family physician (Can$33 000 vs Can$12 000, respectively).4 The benefits of family physicians to patients with cardiac disease are not confined to just those with heart failure. In adults hospitalized from 1994 to 1995 with acute myocardial infarction, there was no difference in survival between cardiologists and family physicians when controlled for accepted variables.5
Financial Disclosures: Dr Wexler reported receiving research funding from the National Institutes of Health, the American Academy of Family Physicians Foundation, and CVRx and serving on the data safety and monitoring board for Cardiomems.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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