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J Am Coll Cardiol. 1998 Oct;32(4):885-9.

Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction.

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  • 1The Lancaster Heart Foundation, Pennsylvania 17603, USA. lanheart@redrose.net

Abstract

OBJECTIVES:

We sought to determine the effect of specialty care on in-hospital mortality in patients with acute myocardial infarction.

BACKGROUND:

There has been increasing pressure to limit access to specialists as a method to reduce the cost of health care. There is little known about the effect on outcome of this shift in the care of acutely ill patients.

METHODS:

We analyzed the data from 30,715 direct hospital admissions for the treatment of acute myocardial infarction in Pennsylvania in 1993. A risk-adjusted in-hospital mortality model was developed in which 12 of 20 clinical variables were significant independent predictors of in-hospital mortality. To determine whether there were factors other than patient risk that significantly influenced in-hospital mortality, multiple logistic regression analysis was performed on physician, hospital and payer variables.

RESULTS:

After adjustment for patient characteristics, a multiple logistic regression analysis identified treatment by a cardiologist (odds ratio=0.83 [confidence interval ¿CI¿=0.74 to 0.94] p < 0.003) and physicians treating a high volume of acute myocardial infarction patients (odds ratio=0.89 [CI=0.80 to 0.99] p < 0.03) as independent predictors of lower in-hospital mortality. Treatment by a cardiologist as compared to primary care physicians was also associated with a significantly lower length of stay for both medically treated patients (p < 0.01) and those undergoing revascularization (p < 0.01).

CONCLUSIONS:

Treatment by a cardiologist is associated with approximately a 17% reduction in hospital mortality in acute myocardial infarction patients. In addition, patients of physicians treating a high volume of patients have approximately an 11% reduction in mortality. This has important implications for the optimal treatment of acute myocardial infarction in the current transformation of the health care delivery system.

PMID:
9768707
[PubMed - indexed for MEDLINE]
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