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Differences in Care That Doctors with Different Specialties Give Patients with Congestive Heart Failure FREE

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The summary below is from the full report titled “Resource Use and Survival of Patients Hospitalized with Congestive Heart Failure: Differences in Care by Specialty of the Attending Physician.” It is in the 1 February 1999 issue of Annals of Internal Medicine (volume 132, pages 191-200). The authors are A.D. Auerbach, M.B. Hamel, R.B. Davis, A.F. Connors Jr., C. Regueiro, N. Desbiens, L. Goldman, R.M. Califf, N.V. Dawson, N. Wenger, H. Vidaillet, and R.S. Phillips, for the SUPPORT Investigators.

Ann Intern Med. 2000;132(3):191. doi:10.7326/0003-4819-132-3-200002010-00030
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What is the problem and what is known about it so far?

Previous studies suggest that cardiologists (heart specialists) and generalist doctors (primary care physicians) give substantially different care to persons with some types of heart disease.

Why did the researchers do this particular study?

The researchers wanted to find out if costs and outcomes of care for people with a particularly common and serious type of heart disease, congestive heart failure, were different depending on whether the patient's main doctor in the hospital was a cardiologist or a generalist.

Who was studied?

The researchers studied 1298 patients who were critically ill with congestive heart failure and were hospitalized at one of five U.S. teaching hospitals between 1989 and 1994. This study was part of a larger research project, the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).

How was the study done?

The researchers collected information about the patients themselves, the type and costs of care they received in the hospital, and the specialty of the main doctor who cared for them. They used information from medical records, telephone follow-up, and the National Death Index to see which patients had died 1, 6, and 12 months later.

What did the researchers find?

Patients of cardiologists were younger and less sick at the time of hospital admission than patients of generalists, but they were more likely to have a history of dangerous abnormal heart rhythms. After correcting for patient characteristics, patients of cardiologists had higher hospital costs and were more likely to undergo invasive heart procedures (for example, cardiac catheterization). The death rates at 1 and 6 months were not different for patients of cardiologists and generalists, but at 1 year the death rate was slightly lower for patients of cardiologists.

What are the limitations of the study?

This study did not take into account whether a cardiologist also saw patients of generalist doctors during the hospital stay, nor did it determine the kind of care patients received after leaving the hospital or who provided that care.

What are the implications of the study?

Compared with the care that generalist doctors provide for patients hospitalized for congestive heart failure, care by a cardiologist may be associated with higher hospital costs and more invasive procedures, but survival 1 and 6 months later does not seem to be different. Survival may be very slightly better for patients of cardiologists at 1 year. It is difficult to know, however, whether that small difference occurred because doctors with different specialties give different types of care or because patients of cardiologists are less sick to begin with.





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