Treatment and Outcomes of Acute Myocardial Infarction Among Patients of Cardiologists and Generalist Physicians
- 8 December 1997
- journal article
- research article
- Published by American Medical Association (AMA) in Archives of Internal Medicine
- Vol. 157 (22), 2570-2576
- https://doi.org/10.1001/archinte.1997.00440430048006
Abstract
Background: Both cardiologists and generalist physicians care for patients with acute myocardial infarction, but little is known about their patients' characteristics, treatments, and outcomes. Methods: We identified attending and consulting physicians, patient characteristics, drugs, procedures, and mortality from clinical and administrative records of 1620 Medicare beneficiaries aged 65 to 79 years who were treated for acute myocardial infarction at 285 hospitals in Texas during 1990. Results: Patients treated by attending cardiologists were younger, had prior congestive heart failure less frequently, and were initially treated in hospitals offering coronary angioplasty or bypass surgery more often than patients treated by attending generalist physicians (for each,P<.004). Adjusting for patient and hospital characteristics, cardiologists were more likely than generalist physicians to prescribe thrombolytic therapy and aspirin (P<.05) but not β-adrenergic blocking agents (β-blockers). Cardiologists used coronary angiography and angioplasty more often (P<.003), but not echocardiography or exercise testing. Adjusted 1-year mortality did not differ significantly between patients of attending cardiologists and generalist physicians (odds ratio, 1.01; 95% confidence interval, 0.76-1.35) or between patients of generalist physicians with and without a consulting cardiologist (odds ratio, 0.83; 95% confidence interval, 0.60-1.16). However, patients initially admitted to hospitals offering coronary angioplasty and bypass surgery had lower adjusted 1-year mortality than patients admitted to other hospitals (odds ratio, 0.68; 95% confidence interval, 0.47-0.98). Conclusions: Compared with generalist physicians, cardiologists used some, but not all, effective drugs more frequently, as well as coronary angiography and angioplasty. Although these differences were not associated with lower adjusted mortality among cardiologists' patients, cardiologists were more likely to treat patients in hospitals with better outcomes. Future studies should identify organizational factors that improve outcomes of myocardial infarction. Arch Intern Med. 1997;157:2570-2576Keywords
This publication has 15 references indexed in Scilit:
- Measuring Quality of CareNew England Journal of Medicine, 1996
- Using admission characteristics to predict short-term mortality from myocardial infarction in elderly patients. Results from the Cooperative Cardiovascular ProjectPublished by American Medical Association (AMA) ,1996
- Research at the Interface of Primary and Specialty CarePublished by American Medical Association (AMA) ,1995
- Outcomes of patients with hypertension and non-insulin dependent diabetes mellitus treated by different systems and specialties. Results from the medical outcomes studyPublished by American Medical Association (AMA) ,1995
- Cardiologist versus internist management of patients with unstable angina: Treatment patterns and outcomesJournal of the American College of Cardiology, 1995
- Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarctionBMJ, 1995
- Variation in the Use of Cardiac Procedures after Acute Myocardial InfarctionNew England Journal of Medicine, 1995
- Access to Specialty CareNew England Journal of Medicine, 1994
- Knowledge and Practices of Generalist and Specialist Physicians Regarding Drug Therapy for Acute Myocardial InfarctionNew England Journal of Medicine, 1994
- Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Analysis using instrumental variablesPublished by American Medical Association (AMA) ,1994