Collaborative Care for Congestive Heart Failure

Veterinary medicine is shifting toward a multitiered model of primary care and referral specialty services, similar to human healthcare. The presumption is that added specialty training and expertise can lead to improved diagnostic accuracy, treatment plans, and patient outcomes. The trade-offs are clients’ financial considerations and primary care veterinarians’ concerns that referral could lead to lost cases and revenue.

The purpose of this retrospective cohort study was to assess outcomes when small-breed dogs with congestive heart failure (CHF) secondary to myxomatous mitral valve disease (MMVD) received collaborative care from a primary care veterinarian (pcDVM) and a board-certified veterinary cardiologist or received care from the primary care veterinarian alone. Medical records of 26 small-breed dogs with naturally occurring MMVD-induced CHF were included in this study.

Results showed that median survival time in dogs that received collaborative care (n = 18) was significantly longer (254 days) as compared with dogs that received care from a pcDVM alone (n = 8; 146 days). No significant difference in mean pcDVM revenue was identified between groups. Additionally, there was a significant positive correlation between survival time and pcDVM revenue for dogs that received collaborative care (ie, longer survival yielded greater revenue from patient care).

The authors concluded that collaborative care may improve outcomes for small-breed dogs with CHF secondary to MMVD while increasing revenue for pcDVMs.

These new study results should help allay fears that referral may inevitably lead to lost clients and income. Referred dogs lived longer, with pcDVM revenue increasing proportionately as survival times increased. There is still a perception that referral to obtain a diagnosis is somehow more worthwhile than referral for optimizing heart failure management, but this study challenged that assumption. A wide range of effective cardiac therapies are at the disposal of pcDVMs,^1,2 and short-term restoration of normal quality of life is achievable in many dogs that are presented with mitral valve disease and heart failure. When the initial response to treatment exceeds the expectations of pcDVMs, subsequent deterioration can be viewed as the inevitable “end of the line,” but these results suggested that is not always the case. Board-certified cardiologists can help extend that period of normal quality of life still further, without sacrificing the involvement (or income) of the pcDVM.

—Virginia Luis Fuentes, MA, VetMB, PhD, CertVR, DVC, MRCVS, DACVIM (Cardiology), DECVIM-CA (Cardiology), Royal Veterinary College, London, United Kingdom