Patient characteristics associated with care by a cardiologist among adults hospitalized with severe congestive heart failure

OBJECTIVES The goal of this study was to determine factors associated with receiving cardiologist care among patients with an acute exacerbation of co ngestive heart failure. BACKGROUND Because cardiologist care for acute cardiovascular illness may i mprove care, barriers to specialty care could impact patient outcomes. METHODS We studied 1,298 patients hospitalized with acute exacerbation of c ongestive heart failure who were cared for by cardiologists or generalist p hysicians. Using multivariable logistic models we determined factors indepe ndently associated with attending cardiologist care. RESULTS Patients were less likely to receive care from a cardiologist if th ey were black (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.35, 0.80), had an income of less than $11,000 (AOR 0.65, 95% CI 0.45, 0. 93) or were older than 80 years of age (AOR 0.23, 95% CI 0.12, 0.46). Patie nts were more likely to receive cardiologist care if they had college level education (AOR 1.89, 95% CI 1.02, 3.51), a history of myocardial infarctio n (AOR 1.59, 95% CI 1.17, 2.16), a serum sodium less than 133 on admission (AOR 1.96, 95% CI 1.30, 2.95) or a systolic blood pressure less than 90 on admission (AOR 1.97, 95% CI 1.20, 3.24). Patients who stated a desire for l ife extending care were also more likely to receive care from a cardiologis t (AOR 1.40, 95% CI 1.04, 1.90). CONCLUSIONS After adjusting for severity of illness and patient preferences for care, patient sociodemographic factors were strongly associated with r eceiving care from a cardiologist. Future investigations are required to de termine whether these associations represent unmeasured preferences for car e or inequities in our health care system. (C) 2000 by the American College of Cardiology.