DIFFERENCES AMONG GERIATRICIANS, GENERAL INTERNISTS, AND CARDIOLOGISTS IN THE CARE OF PATIENTS WITH HEART-FAILURE - A CAUTIONARY TALE OF QUALITY ASSESSMENT

OBJECTIVES: To describe differences in the characteristics, processes of care, and resource utilization of patients with heart failure cared for by geriatricians, general internists, cardiologists, and combinat ions of physicians. DESIGN: A retrospective cohort study. SETTING: An urban academic medical center. PARTICIPANTS: A total of 439 outpatient s with a billing diagnosis of heart failure or cardiomyopathy who were treated by geriatricians, general internists, cardiologists, and comb inations of physicians. MEASUREMENTS: Demographic and clinical charact eristics, medication use, diagnostic testing, hospitalizations, and in patient and outpatient costs were measured. RESULTS: Compared with pat ients of cardiologists, patients cared for by geriatricians were older , more likely to have hypertension, diastolic dysfunction, and high co morbidity, and less likely to undergo echocardiography, cardiac cathet erization, and electrocardiography. Use of angiotensin-converting enzy me inhibitors was similar among patients with reduced systolic functio n. Patients cared for by geriatricians had the same costs, rates of ho spitalization, and likelihood of being symptomatic as patients of card iologists. CONCLUSIONS: The processes of care for patients with heart failure seen solely by geriatricians differ from those for patients se en by other physicians, but the case-mix also varies. Assessment of le ft ventricular function by geriatricians probably needs to be increase d. However, although they were older and had more comorbidity, patient s of geriatricians had total costs and symptomatology similar to those of patients of cardiologists. Future work is needed to identify those patients most likely to benefit from treatment by geriatricians and t o determine how care can be optimally coordinated among different type s of physicians and health providers.