title: Patient characteristics associated with care by a cardiologist among adults hospitalized with severe congestive heart failure. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.
abstract: OBJECTIVE
  The goal of this study was to determine factors associated with receiving cardiologist care among patients with an acute exacerbation of congestive heart failure.
  
  
  BACKGROUND
  Because cardiologist care for acute cardiovascular illness may improve care, barriers to specialty care could impact patient outcomes.
  
  
  METHODS
  We studied 1,298 patients hospitalized with acute exacerbation of congestive heart failure who were cared for by cardiologists or generalist physicians. Using multivariable logistic models we determined factors independently associated with attending cardiologist care.
  
  
  RESULTS
  Patients were less likely to receive care from a cardiologist if they 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). Patients 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 infarction (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 life extending care were also more likely to receive care from a cardiologist (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 receiving care from a cardiologist. Future investigations are required to determine whether these associations represent unmeasured preferences for care or inequities in our health care system.
authors: Department of Medicine, University of California San Francisco, 94143-0120, USA. ada@medicine.ucsf.edu
authors: A D
authors: AD
authors: Auerbach
authors: M B
authors: MB
authors: Hamel
authors: R M
authors: RM
authors: Califf
authors: R B
authors: RB
authors: Davis
authors: N S
authors: NS
authors: Wenger
authors: N
authors: N
authors: Desbiens
authors: L
authors: L
authors: Goldman
authors: H
authors: H
authors: Vidaillet
authors: A F
authors: AF
authors: Connors
authors: J
authors: J
authors: Lynn
authors: N V
authors: NV
authors: Dawson
authors: R S
authors: RS
authors: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000145:classification*; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000145:classification*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012959:Socioeconomic Factors; D014481:United States; D000078329:Workforce