PATIENTS TREATED BY CARDIOLOGISTS HAVE A LOWER IN-HOSPITAL MORTALITY FOR ACUTE MYOCARDIAL-INFARCTION

Objectives. We sought to determine the effect of specialty care on in hospital mortality in patients with acute myocardial infarction. Backg round. There has been increasing pressure to limit access to specialis ts as a method to reduce the cost of health care. There is little know n about the effect on outcome of this shift in the care of acutely ill patients. Methods. We analyzed the data from 30,715 direct hospital a dmissions for the treatment of acute myocardial infarction in Pennsylv ania in 1993, A risk adjusted in-hospital mortality model was develope d in which 12 of 20 clinical variables were significant independent pr edictors of in hospital mortality. To determine whether there were fac tors other than patient risk that significantly influenced in-hospital mortality, multiple logistic regression analysis was performed on phy sician, hospital and payer variables. Results. After adjustment for pa tient characteristics, a multiple logistic regression analysis identif ied treatment by a cardiologist (odds ratio = 0.83 [confidence interva l {CI} = 0.74 to 0.94] p < 0.003) and physicians treating a high volum e of acute myocardial infarction patients (odds ratio = 0.89 [CI = 0.8 0 to 0.99] p < 0.03) as independent predictors of lower in-hospital mo rtality. Treatment by a cardiologist as compared to primary care physi cians was also associated with a significantly lower length of stay fo r both medically treated patients (p < 0.01) and those undergoing reva scularization (p < 0.01). Conclusions. Treatment by a cardiologist is associated with approximately a 17% reduction in hospital mortality in acute myocardial infarction patients. In addition, patients of physic ians treating a high volume of patients have approximately an 11% redu ction in mortality. This has important implications for the optimal tr eatment of acute myocardial infarction in the current transformation o f the health care delivery system. (C) 1998 by the American College of Cardiology.