Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction.

Abstract

OBJECTIVES:

We sought to determine the effect of specialty care on in-hospital mortality in patients with acute myocardial infarction.

BACKGROUND:

There has been increasing pressure to limit access to specialists as a method to reduce the cost of health care. There is little known about the effect on outcome of this shift in the care of acutely ill patients.

METHODS:

We analyzed the data from 30,715 direct hospital admissions for the treatment of acute myocardial infarction in Pennsylvania in 1993. A risk-adjusted in-hospital mortality model was developed in which 12 of 20 clinical variables were significant independent predictors of in-hospital mortality. To determine whether there were factors other than patient risk that significantly influenced in-hospital mortality, multiple logistic regression analysis was performed on physician, hospital and payer variables.

RESULTS:

After adjustment for patient characteristics, a multiple logistic regression analysis identified treatment by a cardiologist (odds ratio=0.83 [confidence interval ¿CI¿=0.74 to 0.94] p < 0.003) and physicians treating a high volume of acute myocardial infarction patients (odds ratio=0.89 [CI=0.80 to 0.99] p < 0.03) as independent predictors of lower in-hospital mortality. Treatment by a cardiologist as compared to primary care physicians was also associated with a significantly lower length of stay for both medically treated patients (p < 0.01) and those undergoing revascularization (p < 0.01).

CONCLUSIONS:

Treatment by a cardiologist is associated with approximately a 17% reduction in hospital mortality in acute myocardial infarction patients. In addition, patients of physicians treating a high volume of patients have approximately an 11% reduction in mortality. This has important implications for the optimal treatment of acute myocardial infarction in the current transformation of the health care delivery system.

• Authors: P N Casale, J L Jones, F E Wolf, Y Pei, L M Eby
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 32 Issue 4 Pg. 885-9 (Oct 1998) ISSN: 0735-1097 [Print] United States
• PMID: 9768707 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Aged
• Cardiology
• Female
• Hospital Mortality
• Humans
• Insurance, Health
• Male
• Myocardial Infarction (mortality, therapy)
• Physicians, Family