Comparison of treatment of patients with congestive heart failure by cardiologists versus noncardiologists

PURPOSE: The frequency of treatment with Heart Failure Society of America (HFSA)-recommended medications for the management of congestive heart failure (CHF) by cardiologists versus noncardiologists was studied. METHODS: The medical records of 227 patients admitted to our institution between January and June 2000 with a discharge diagnosis of CHF were retrospectively reviewed. Data collected included demographic information and medical history, severity of illness, prescribed level of hospital care at the time of admission, diagnostic evaluations conducted during admission, medications prescribed at admission and discharge, and any noted contraindications to these medications. Data for patients treated by cardiologists versus noncardiologists were compared. RESULTS: Patients treated by cardiologists were significantly more likely to be admitted to an intensive care unit; receive chest x-rays, electrocardiograms, nuclear medicine tests, cardiac catheterizations, and stress tests; and have their weight monitored daily than were patients treated by noncardiologists. The majority of patients with CHF who were eligible for an angiotensin-converting-enzyme (ACE) inhibitor, a beta-blocker, or an aldosterone antagonist did not receive these medications, regardless of the treating physician. Cardiologists prescribed significantly more beta-blockers and aldosterone antagonists for eligible patients at hospital admission. Greater differences were seen in discharge medications, as cardiologists were significantly more likely to prescribe ACE inhibitors, digoxin, beta-blockers, and aldosterone antagonists. CONCLUSION: Hospitalized patients with CHF were more likely to receive HFSA-recommended medications on admission and discharge when treated by cardiologists versus noncardiologists. Neither cardiologists nor noncardiologists prescribed ACE inhibitors to all eligible patients as frequently as recommended by HFSA guidelines.