OUTCOME OF ACUTE MYOCARDIAL, INFARCTION ACCORDING TO THE SPECIALTY OFTHE ADMITTING PHYSICIAN

Background In order to limit costs, health care organizations in the U nited States are shifting medical care from specialists to primary car e physicians. Although primary care physicians provide less resource-i ntensive care, there is little information concerning the effects of t his strategy on outcomes. Methods We examined mortality according to t he specialty of the admitting physician among 8241 Medicare patients w ho were hospitalized for acute myocardial infarction in four states du ring a seven-month period in 1992. proportional-hazards regression mod els were used to examine survival up to one year after the myocardial infarction. To determine the generalizability of our findings, we also examined insurance claims and survival data for all 220,535 patients for whom there were Medicare claims for hospital care for acute myocar dial infarction in 1992. Results After adjustment for characteristics of the patients and hospitals, patients who were admitted to the hospi tal by a cardiologist were 12 percent less likely to die within one ye ar than those admitted by a primary care physician (P<0.001). Cardiolo gists also had the highest rate of use of cardiac procedures and medic ations, including medications (such as thrombolytic agents and beta-bl ockers) that are associated with improved survival. Conclusions Health care strategies that shift the care of elderly patients with myocardi al infarction from cardiologists to primary care physicians lower rate s of use of resources (and potentially lower costs), but they may also cause decreased survival. Additional information is needed to elucida te how primary care physicians and specialists should interact in the care of severely ill patients.