Differences between patients with heart failure treated by cardiologists, internists, family physicians, and other physicians: Analysis of a large, statewide database

Background The management of heart failure (HF) by cardiologists may be bet ter than that of other physicians in that cardiologists' treatment choices more frequently conform with published guidelines and the results of clinic al trials. Whether cardiologists' management of HF is more or less cost-eff ective is up for debate. Methods Information on all 1995 New York state hospital discharges assigned ICD-9-CM codes indicative of HF in the principal diagnosis position was ob tained. Demographic and clinical characteristics, process of care, resource utilization, and short-term HF-related outcomes were compared between pati ents of cardiologists and patients of other physicians. Results A total of 44,926 patients were identified, with 10,506 (23%) recei ving care from cardiologists, 28,300 (63%) from internists 4812 (11%) from family practitioners, and 1308 (3%) from other physicians. Patients of card iologists were younger, more frequently male, and less frequently residents of nursing homes. They were more likely to have associated cardiovascular diagnoses but less likely to have comorbid general medical conditions. Pati ents of cardiologists were more likely to undergo cardiac catheterization ( 9%) than those of internists (3%) and family practice (2%) physicians but h ad similar adjusted hospital length of stay and charges. Mortality and hosp ital readmission rates for HF were similar among the groups. Patients in th e "other" group (managed mostly by surgeons) were the youngest, underwent m ore invasive and cardiac surgical procedures, and had the longest length of stay and highest hospital charges. Conclusions Cardiologists' management of HF is not economically disadvantag eous. The relations among physician specialty, process of care, resource ut ilization, and clinical outcomes require further study before rational and evidence-based health care staffing recommendations can be formulated.