Study objectives: Severity of illness, treatment
choices, and clinical outcomes may vary with physician training. This
study was performed to determine whether such differences exist among
patients with congestive heart failure (CHF) treated by cardiologists
and by noncardiologists in the community hospital setting.
Design: Prospective cohort study.
Ten acute-care community hospitals.
measurements, and results: Two thousand four hundred fifty-four
patients with CHF were identified and followed up for 6 months after
hospital discharge. Patients who were not treated by a cardiologist
(group I; n = 977) were compared with patients whose attending
physician was a cardiologist (group II; n = 419) and patients who
received consultative care from a cardiologist (group III;
n = 1,058). When compared with group I patients, group II patients
were more likely to receive the recommended diagnostic tests and
treatment strategies, although some of these differences could be
explained by variations in the case mix. Group II patients had higher
hospital charges, but lower CHF readmission rates and better
postdischarge quality-of-life measures. No differences in adjusted
mortality rates were observed.
the community-hospital setting, the clinical practices of cardiologists
are more compatible with published treatment guidelines than the
clinical practices of other physicians. The benefits of
cardiology specialty care include lower CHF readmission rates and
better postdischarge quality-of-life measures, rather than lower
mortality rates, fewer hospital charges, or shorter length of