OUTCOMES MANAGEMENT

Heart attack sufferers experience better outcomes when their attending physician is a cardiologist than when he or she is a family physician or an internist, says a study published in the Journal of the American College of Cardiology. Other have found cardiologists to be more aware of and willing to rely on cutting-edge therapies, but few have analyzed how these patterns affect patient outcomes, including mortality.

Researchers at Mount Sinai Medical Center in New York City and Thomas Jefferson University Hospital in Philadelphia evaluated 40,684 admissions for acute myocardial infarction to Pennsylvania hospitals in 1993.

Patients treated by cardiologists spent less time in the hospital and had a lower rate of mortality. If the 12,960 who were treated by the internists had been seen by cardiologists, 285 fewer deaths would have occurred, the investigators said. And if cardiologists had treated the 6,791 seen by FPs, there would have been 174 fewer deaths.

The study also found differences among patients of cardiologists, internists and family physicians in mean number of hospital days — 7.0, 8.5 and 8.3, respectively.

The authors acknowledge that their findings are not the last word on specialty vs. generalist care of heart attack patients. The study was limited, the authors said, because in some cases it was difficult to determine who the patient's attending physician was.

Just what practice patterns cardiologists use — or primary care physicians don't use — to better treat patients were not determined. "This is not by any means a settled issue," says Ira S. Nash, M.D., associate director of the Cardiovascular Institute at Mount Sinai, the study's lead author.

Hospital mortality by attending physician
Physician Number of patients Actual mortality & rate Risk-adjusted mortality rate Risk ratio
Cardiologist 16,996 1,341 (7.9%) 8.6% 1.00
Internist 12,960 1,555 (12.0%) 10.8% 1.26
Family physician 6,971 772 (11.1%) 11.1% 1.29
SOURCE: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 2, NO. 3

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