Predictors of cardiologist care for older patients hospitalized for heart failure.
BACKGROUND
Studies have suggested that cardiologists may provide higher quality heart failure care than generalists. However, national rates of specialty care during hospitalization for heart failure and factors associated with care by a cardiologist are unknown.


METHODS
We assessed specialty care in a sample of Medicare patients hospitalized nationwide with heart failure between 1998 and 1999 (n = 25,869). Multivariable hierarchical logistic regression models were used to identify factors independently associated with treatment by a cardiologist.


RESULTS
One-quarter (25.5%) of patients had a cardiologist as their attending physician, 31.3% of patients received a cardiology consult, and 43.2% of patients were not treated by a cardiologist during hospitalization. Older patients (age <75 years: referent; age 75-84 years: risk ratio [RR], 0.92; 95% CI, 0.86-0.98; age > or =85 years: RR, 0.81; 95% CI, 0.74-0.88) and women (RR, 0.87; 95% CI, 0.83-0.93) were less likely to have an attending cardiologist. Patients with a history of heart failure (RR, 1.13; 95% CI, 1.06-1.20), coronary disease (RR, 1.23; 95% CI, 1.14-1.32), coronary artery bypass grafting (RR, 1.42; 95% CI, 1.32-1.42), or percutaneous transluminal coronary angioplasty (RR, 1.30; 95% CI, 1.19-1.42) were more likely to be treated by a cardiologist, whereas patients with chronic obstructive pulmonary disease (RR, 0.74; 95% CI, 0.70-0.79) and dementia (RR, 0.61; 95% CI, 0.54-0.70) were less likely to be treated by a cardiologist. Patient race was not associated with treatment by a cardiologist. The strongest predictors of attending cardiology care were hospital factors, including large volume (>300 beds; RR, 1.45; 95% CI, 1.32-1.42) and geographic location (RR, 1.00 Northeast (referent) vs RR, 0.55; 95% CI 0.46-0.65 Midwest).


CONCLUSIONS
Slightly more than half of older patients with heart failure received care from a cardiologist. Several patient characteristics, including age and sex, were associated with the use of specialty care, suggesting that factors other than clinical presentation may independently influence the use of specialty care.
Foody
JoAnne Micale
JM
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn 06520-8025, USA.
Rathore
Saif S
SS
Wang
Yongfei
Y
Herrin
Jeph
J
Masoudi
Frederick A
FA
Havranek
Edward P
EP
Radford
Martha J
MJ
Krumholz
Harlan M
HM
D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000592:standards / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006333:Heart Failure / Q000208:ethnology / Q000628:therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D012737:Sex Factors