A systematic review of the effects of physician specialty on the treatment of coronary disease and heart failure in the United States.
OBJECTIVE
To assess the effects of physician specialty on the knowledge, management, and outcomes of patients with coronary disease or heart failure.


METHODS
We performed a systematic search of MEDLINE from 1980 to 1997, as well as bibliographic references to articles about the effects of physician specialty on the knowledge, treatment, and outcomes of patients with coronary disease or heart failure in the United States.


RESULTS
Twenty-four articles met our criteria for inclusion (including eight that involved knowledge or self-reported practices, 14 that described actual practice patterns, and six that measured clinical outcomes). Cardiologists were more knowledgeable than generalist physicians about the optimal evaluation and management of coronary disease but not about the use of angiotensin-converting enzyme (ACE) inhibitors for heart failure. Patients with unstable angina or myocardial infarction were more likely to receive proven medical therapies, and possibly had improved outcomes, if they were treated by cardiologists. The use of lipid-lowering drugs after myocardial infarction was also more common among patients of cardiologists. ACE inhibitor use for heart failure was probably greater, and short-term readmission rates were lower, with cardiology care.


CONCLUSIONS
Patients with coronary disease or heart failure in the United States who are treated by cardiologists appear more likely to receive evidence-based care and probably have better outcomes. Investigation of collaborative models of care and innovative efforts to improve the use of proven therapies by physicians are needed.
Go
A S
AS
Division of Research, Kaiser Permanente Medical Care Program (Northern California), Oakland, California 94611-5714, USA.
Rao
R K
RK
Dauterman
K W
KW
Massie
B M
BM
D002309:Cardiology; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000628:therapy*; D019468:Disease Management; D005194:Family Practice; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007388:Internal Medicine; D008511:Medicine; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012107:Research Design; D013038:Specialization; D014481:United States