TREATMENT AND OUTCOMES OF ACUTE MYOCARDIAL-INFARCTION AMONG PATIENTS OF CARDIOLOGISTS AND GENERALIST PHYSICIANS

Citation
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
Citations number
36
Categorie Soggetti
Medicine, General & Internal
ISSN journal
00039926
Volume
157
Issue
22
Year of publication
1997
Pages
2570 - 2576
Database
ISI
SICI code
0003-9926(1997)157:22<2570:TAOOAM>2.0.ZU;2-#
Abstract
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.