Care and outcomes of elderly patients with acute myocardial infarction by physician specialty: the effects of comorbidity and functional limitations
Key result
Cardiology care shows no 1-year AMI survival benefit over generalists after adjusting for comorbidities and therapies.
- RR 0.97
- 95% CI 0.94-1.0
- n=109,243
Why the study?
Whether patients with acute myocardial infarction treated by cardiologists have better outcomes than those treated by generalist physicians is controversial due to differences in patient characteristics.
Does care by cardiologists improve survival in elderly patients with acute myocardial infarction compared to generalist physicians?
Population
109,243 Medicare beneficiaries hospitalized for myocardial infarction from 1994 to 1995
Comparison
Care by board-certified cardiologists vs general practitioners vs general internists as attending physicians
Design
Cohort study using national Cooperative Cardiovascular Project data
Follow-up
1 year
Authors
Discussion
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Member takes
Implication
Case-mix adjustment attenuates apparent survival benefit of cardiologist care in AMI; leaves open whether specialty improves outcomes after full adjustment.
Study Design
Type
Cohort (n=109,243)
Multicenter
Yes
Structured PICO
Does care by cardiologists improve survival in elderly patients with acute myocardial infarction compared to generalist physicians?
P
Population
109,243 Medicare beneficiaries hospitalized for acute myocardial infarction, evaluated for 1-year mortality based on attending physician specialty.
E
Exposure
Care by board-certified cardiologists as attending physicians
C
Comparator
Care by general practitioners or general internists as attending physicians
O
Outcome
30-day and 1-year mortalityhard clinical
Main Result
Relative Risk: 0.97 (95% CI 0.94–1)
The apparent survival benefit of cardiology care for acute myocardial infarction is largely explained by differences in patient case-mix (fewer comorbidities) and greater use of guideline-supported therapies.
Cite This Study
Chen et al. (2000) conducted a cohort in acute myocardial infarction (n=109,243). Care by board-certified cardiologists vs. Care by general internists was evaluated on 1-year mortality (RR 0.97, 95% CI 0.94-1.0). The 1-year survival benefit of cardiology care for acute myocardial infarction was attenuated after adjusting for comorbidities (RR 0.97; 95% CI 0.94-1.0) and guideline-supported therapies.