Physician specialty and mortality among elderly patients hospitalized with heart failure.
BACKGROUND
Whether specialty care improves survival among patients with heart failure remains controversial.


METHODS
We evaluated specialty care and outcomes in 25869 Medicare beneficiaries hospitalized with heart failure in the United States from 1998 through 1999. Patients were classified based on the specialty of their attending physician: cardiologist, internist, general physician, or family physician. The primary outcome of interest was all-cause mortality within 30 days of admission.


RESULTS
Cardiologists were attending physicians for 26%, internists for 50%, and general and family physicians cared for the remainder. Mortality at 30 days was lowest for patients cared for by cardiologists (8.8%), higher for patients cared for by internists (10.0%, relative risk [RR] = 1.07; 95% confidence interval [CI]: 0.97 to 1.19; P = 0.059) and general physicians (11.1%, RR = 1.26; 95% CI: 0.99 to 1.58; P = 0.086), and highest for patients cared for by family physicians (12.0%, RR = 1.31; 95% CI: 1.15 to 1.49; P <0.001). Patients cared for by family physicians remained at higher 30-day mortality rates whether with (RR = 1.30; 95% CI: 1.11 to 1.52) or without consultation with cardiologists (RR = 1.31; 95% CI: 1.13 to 1.52).


CONCLUSIONS
Hospitalized patients with heart failure had lower 30-day mortality when treated by cardiologists than when they were treated by other physicians. Although these differences were modest (RR = 1.07) for internists, they were substantial for general physicians (RR = 1.26) and family physicians (RR = 1.31); of note was that inpatient cardiology consultation did not appear to change this relation.
Foody
JoAnne Micale
JM
Section of Cardiovascular Medicine, Department of Internal Medicine, New Haven, Conn 06520-8025, USA. joanne.foody@yale.edu
Rathore
Saif S
SS
Wang
Yongfei
Y
Herrin
Jeph
J
Masoudi
Frederick A
FA
Havranek
Edward P
EP
Krumholz
Harlan M
HM
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008511:Medicine / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013038:Specialization; D014481:United States / Q000453:epidemiology