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Physician specialty and mortality among elderly patients hospitalized with heart failure

  • JoAnne Micale Foody
    Correspondence
    Requests for reprints should be addressed to JoAnne M. Foody, MD, Yale University School of Medicine, 333 Cedar Street, Room 315B SHM, New Haven, CT 06520-8025
    Affiliations
    Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Conn

    The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn

    Colorado Foundation for Medical Care, Aurora, Colo

    Qualidigm, Middletown, Conn
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  • Saif S. Rathore
    Affiliations
    Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Conn
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  • Yongfei Wang
    Affiliations
    Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Conn
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  • Jeph Herrin
    Affiliations
    Flying Buttress Associates, Va
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  • Frederick A. Masoudi
    Affiliations
    Colorado Foundation for Medical Care, Aurora, Colo

    Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, Colo

    Division of Cardiology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colo

    Geriatric Medicine, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colo
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  • Edward P. Havranek
    Affiliations
    Colorado Foundation for Medical Care, Aurora, Colo

    Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, Colo

    Division of Cardiology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colo
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  • Harlan M. Krumholz
    Affiliations
    Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Conn

    Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Conn

    The Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn

    Colorado Foundation for Medical Care, Aurora, Colo

    Qualidigm, Middletown, Conn
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      Abstract

      Background

      Whether specialty care improves survival among patients with heart failure remains controversial.

      Methods

      We evaluated specialty care and outcomes in 25 869 Medicare beneficiaries hospitalized with heart failure in the United States from 1998 through 1999. Patients were classified based on the specialty of their attending physician: cardiologist, internist, general physician, or family physician. The primary outcome of interest was all-cause mortality within 30 days of admission.

      Results

      Cardiologists were attending physicians for 26%, internists for 50%, and general and family physicians cared for the remainder. Mortality at 30 days was lowest for patients cared for by cardiologists (8.8%), higher for patients cared for by internists (10.0%, relative risk [RR] = 1.07; 95% confidence interval [CI]: 0.97 to 1.19; P = 0.059) and general physicians (11.1%, RR = 1.26; 95% CI: 0.99 to 1.58; P = 0.086), and highest for patients cared for by family physicians (12.0%, RR = 1.31; 95% CI: 1.15 to 1.49; P <0.001). Patients cared for by family physicians remained at higher 30-day mortality rates whether with (RR = 1.30; 95% CI: 1.11 to 1.52) or without consultation with cardiologists (RR = 1.31; 95% CI: 1.13 to 1.52).

      Conclusion

      Hospitalized patients with heart failure had lower 30-day mortality when treated by cardiologists than when they were treated by other physicians. Although these differences were modest (RR = 1.07) for internists, they were substantial for general physicians (RR = 1.26) and family physicians (RR = 1.31); of note was that inpatient cardiology consultation did not appear to change this relation.

      Keywords

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