Physician specialty and quality of care for CHF: different patients or different patterns of practice?
BACKGROUND
Previous reports have suggested that internists employ evidence-based care for congestive heart failure (CHF) less frequently than cardiologists. Reasons for this possible difference are unclear.


METHODS
A retrospective review of 185 consecutive patients admitted to a Canadian tertiary care facility between April 1998 and March 1999 with a primary diagnosis of CHF and who were treated by internists (IM group) or cardiologists (CARD group) was conducted.


RESULTS
The CARD group (n=65) was younger (70 versus 76 years, P<0.001) and had larger left ventricular end-diastolic diameter by echocardiography (57 versus 51 mm, P=0.006) than the IM group (n=120). The CARD group documented ejection fraction in 90% of cases versus 54% in the IM group (P<0.05). There was no difference in angiotensin-converting enzyme (ACE) inhibitor usage (68% versus 63%, P=0.48) or optimal ACE dosage (CARD 50% versus IM 42%, P=0.44). Multivariate predictors of ACE inhibitor usage were serum creatinine, male sex, peripheral edema and increasing serum glucose. The CARD group had higher usage of beta-blockers (69% versus 49%, P<0.009), lipid lowering medication (35% versus 17%, P<0.004) and warfarin therapy for atrial fibrillation (74% versus 28%, P<0.005).


CONCLUSIONS
The data suggest that Canadian cardiologists and internists use ACE inhibitors equally and care for a relatively similar group of CHF patients. However, beta-blockade, warfarin, lipid lowering therapy and documentation of critical data occurred more frequently under cardiologist care. The possibility that there may be a gradation of adoption of newer guidelines for CHF care according to physician specialty is raised.
Howlett
Jonathan G
JG
Division of Cardiology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. jonathan.howlett@cdha.nshealth.ca
Cox
Jafna L
JL
Haddad
Haissam
H
Stanley
Jennie
J
McDonald
Michael
M
Johnstone
David E
DE
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D002309:Cardiology / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D000960:Hypolipidemic Agents / Q000008:administration & dosage; D007388:Internal Medicine / Q000592:standards*; D008297:Male; D008499:Medical Records; D009674:Nova Scotia; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D014859:Warfarin / Q000008:administration & dosage
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D014859:Warfarin