Cardiology or primary care for heart failure in the community setting - Process of care and clinical outcomes

Study objectives: Severity of illness, treatment choices, and clinical outc omes may vary with physician training, This study was performed to determin e whether such differences exist among patients with congestive heart failu re (CHF) treated by cardiologists and by noncardiologists in the community hospital setting. Design: Prospective cohort study. Setting: Ten acute-care community hospitals, Patients, measurements, and results: Two thousand four hundred fifty-four p atients with CHF were identified and followed up for 6 months after hospita l discharge, Patients who were not treated by a cardiologist (group I; n = 977) were compared with patients whose attending physician was a cardiologi st (group II; n = 419) and patients who received consultative care from a c ardiologist (group III; n = 1,058), When compared with group I patients, gr oup II patients were more likely to receive the recommended diagnostic test s and treatment strategies, although some of these differences could be exp lained by variations in the case mix. Group II patients had higher hospital charges, but lower CHF readmission rates and better postdischarge quality- of-life measures. No differences in adjusted mortality rates were observed, Conclusions: In the community-hospital setting, the clinical practices of c ardiologists are more compatible with published treatment guidelines than t he clinical practices of other physicians. The benefits of cardiology speci alty care include lower CHF readmission rates and better postdischarge qual ity-of-life measures, rather than lower mortality rates, fewer hospital cha rges, or shorter length of stay.