Jz. Ayanian et al., TREATMENT AND OUTCOMES OF ACUTE MYOCARDIAL-INFARCTION AMONG PATIENTS OF CARDIOLOGISTS AND GENERALIST PHYSICIANS, Archives of internal medicine, 157(22), 1997, pp. 2570-2576
Background: Both cardiologists and generalist physicians care for pati
ents with acute myocardial infarction, but little is known about their
patients' characteristics, treatments, and outcomes. Methods: We iden
tified attending and consulting physicians, patient characteristics, d
rugs, procedures, and mortality from clinical and administrative recor
ds of 1620 Medicare beneficiaries aged 65 to 79 years who were treated
for acute myocardial infarction at 285 hospitals in Texas during 1990
. Results: Patients treated by attending cardiologists were younger, h
ad prior congestive heart failure less frequently, and were initially
treated in hospitals offering coronary angioplasty or bypass surgery m
ore often than patients treated by attending generalist physicians (fo
r each, P<.004). Adjusting for patient and hospital characteristics, c
ardiologists were more likely than generalist physicians to prescribe
thrombolytic therapy and aspirin (P<.05) but not beta-adrenergic block
ing agents (beta-blockers). Cardiologists used coronary angiography an
d angioplasty more often (P<.003), but not echocardiography or exercis
e testing. Adjusted 1-year mortality did not differ significantly betw
een patients of attending cardiologists and generalist physicians (odd
s ratio, 1.01; 95% confidence interval, 0.76-1.35) or between patients
of generalist physicians with and without a consulting cardiologist (
odds ratio, 0.83; 95% confidence interval, 0.60-1.16). However, patien
ts initially admitted to hospitals offering coronary angioplasty and b
ypass surgery had lower adjusted 1-year mortality than patients admitt
ed to other hospitals (odds ratio, 0.68; 95% confidence interval, 0.47
-0.98). Conclusions: Compared with generalist physicians, cardiologist
s used some, but not all, effective drugs more frequently, as well as
coronary angiography and angioplasty. Although these differences were
not associated with lower adjusted mortality among cardiologists' pati
ents, cardiologists were more likely to treat patients in hospitals wi
th better outcomes. Future studies should identify organizational fact
ors that improve outcomes of myocardial infarction.