Audit of Cardiology Specialty Referrals in a Nigerian Tertiart Hospital

Cardiology Specialty Referrals

Abstract

Background: Referrals to cardiology specialists are common, but many are inappropriate, potentially straining resources and delaying care for patients with true cardiac pathology. This study audited referrals to a cardiology service to assess the yield of confirmed cardiac diagnoses and identify patterns of referral appropriateness.

Methodology: The study was conducted over one month at the Cardiology Unit of the Lagos State University Teaching Hospital (LASUTH). Data on patients’ demographics, referral sources, cardiovascular risk factors, provisional and final diagnoses were collected. Descriptive statistics, including means and percentages, were used to analyse categorical data, while non-parametric data were analysed with Student’s t-test and ANOVA.

Results: A total of 121 patients (67 males and 54 females; mean age: 53.9 ± 15.7 years) were referred. Nearly half (49.5%) of referrals were from within the Department of Medicine, with 45.5% from other departments and 5% from external facilities. Hypertension was the most prevalent risk factor (62.8%), followed by diabetes mellitus (3.3%) and obesity (1.7%). The highest diagnostic yield was observed for arrhythmias, heart block, and thromboembolic diseases. However, 19.8% of referrals resulted in no identifiable cardiac disease. Incorrect provisional diagnoses were most common for coronary artery disease (60% error rate).

Conclusion: The rate of inappropriate referrals to the cardiology service is high, with significant proportions originating from within the same department. Arrhythmias and thromboembolic diseases yielded the highest rates of appropriate referrals, while coronary artery disease had the lowest. Targeted training for referrers on cardiovascular disease evaluation, particularly ECG interpretation, is recommended to optimise cardiology service utilisation.