Outcome after acute myocardial infarction: a comparison of patients seen by cardiologists and general physicians

Abstract

BackgroundThe management of acute myocardial infarction (AMI) has improved over the last 50 years with the more frequent use of effective medicines and procedures. The clinical benefit of the speciality of the attending physician is less clear. The United Kingdom National Service Framework for coronary heart disease (CHD) suggested that patients with CHD are likely to benefit from cardiological supervision. We set out to assess the effect of access to cardiologists on survival among AMI patients admitted in two UK hospitals.MethodsThe study was conducted in a university hospital and a district general hospital in England. Information was obtained on age, sex, ethnicity, Carstairs socioeconomic deprivation category derived from postcode of residence, comorbidity, distance from hospital and medication from all patients admitted with acute myocardial infarction in two acute trusts between July 1999 and June 2000. Record linkage to subsequent Hospital Episode Statistics and Registrar General's death records provided follow up information on procedures and mortality up to eighteen months after admission. Cox proportional hazard models were used to investigate the main hypothesis controlling for confounding. The main outcome measure was 18-month survival after myocardial infarction.ResultsAccess to a cardiologist was univariately associated with improved survival (hazard ratio 0.16, 95% CI 0.10 to 0.25). This effect remained after controlling for the effect of patient characteristics (hazard ratio 0.22, 95% CI 0.14 to 0.25). The effect disappeared after controlling for access to effective medication (hazard ratio 0.70, 95% CI 0.33 to 1.46).ConclusionsAccess to a cardiologist is associated with better survival compared to no access to a cardiologist among a cohort of patients already admitted with AMI. This effect is mainly due to the more frequent use of effective medicines by the group referred to cardiologists. Hospitals may improve survival by improving access to effective medicines and by coordinating care between cardiologists and general physicians.

Regional Density of Cardiologists and Rates of Mortality for Acute Myocardial Infarction and Heart Failure

“…First, patients hospitalized in regions with a high density of cardiologists may be more likely to receive care from a cardiologist—either inpatient treatment or outpatient follow-up after discharge—and numerous studies have demonstrated that patients treated by cardiologists have better short-term and long-term outcomes. 2–10 Second, the density of cardiologists may correlate with cardiology care quality. Cardiologists in regions with a high density may face more competition, which may result in higher quality of care among those who are able to sustain a practice.…”

“…Studies have reported that patients with acute myocardial infarction (AMI) or heart failure (HF) have lower mortality when a cardiologist is part of their inpatient treatment team 2–8 or when they receive care from a cardiologist after discharge. 9,10 Additionally, several studies in other specialties have shown relationships between regional density of healthcare providers and outcomes.…”

Análise da atenção pré-hospitalar ao acidente vascular cerebral e ao infarto agudo do miocárdio na população idosa de minas gerais

“…Likewise, a beneficial effect of the presence of SAMU was observed for mortality from stroke in men and for both in-hospital morbidity and mortality due to AMI in women. Despite widespread criticism of the quality of primary care delivered to patients with chronic diseases, [18][19] , there is evidence suggesting an improvement in prognosis, at least for stroke, associated with ESF coverage 20 . One can observe a consistency in the beneficial effects of both components of PNAU, stationary (ESF) and mobile (SAMU) components, on the indicators selected for this study.…”

Mortality in Peripheral Arterial Disease: A Comparison of Patients Managed by Vascular Specialists and General Practitioners

“…Evidence suggests that specialists and generalist physicians have different approaches to cardiovascular patients 1–3. General practitioners (GPs) provide care that is less resource-intensive and, thus, potentially less expensive, but may be less aware of key diagnostic and therapeutic advances.…”

“…General practitioners (GPs) provide care that is less resource-intensive and, thus, potentially less expensive, but may be less aware of key diagnostic and therapeutic advances. This may lead to worse outcomes 1–3…”