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CLINICAL STUDY: HEART FAILURE

Patient characteristics associated with care by a cardiologist among adults hospitalized with severe congestive heart failure

Andrew D. Auerbach, MD, MPH^*, Mary Beth Hamel, MD, MPH, Robert M. Califf, MD, FACC, Roger B. Davis, ScD, Neil S. Wenger, MD, Norman Desbiens, MD^||, Lee Goldman, MD, MPH, FACC^*, Humberto Vidaillet, MD, FACC^¶, Alfred F. Connors, MD^#, Joanne Lynn, MD^**, Neal V. Dawson, MD, Russell S. Phillips, MD for the SUPPORT Investigators

^* Department of Medicine, University of California San Francisco, San Francisco, California, USA
Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Duke University Medical Center, Durham, North Carolina, USA
University of California Los Angeles, Los Angeles, California, USA
^|| Chattanooga Unit, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
^¶ Marshfield Clinic, Marshfield, Wisconsin, USA
^# University of Virginia School of Medicine, Charlottesville, Virginia, USA
^** Center to Improve Care of the Dying, Washington, DC, USA
MetroHealth Medical Center, Cleveland, Ohio, USA

Manuscript received April 7, 2000; revised manuscript received July 11, 2000, accepted August 18, 2000.

Reprint requests and correspondence: Dr. Andrew Auerbach, Department of Medicine, University of California, San Francisco, Department of Medicine-Box 0120, San Francisco, California 94143-0120
ada{at}medicine.ucsf.edu

OBJECTIVES

The goal of this study was to determine factors associated with receiving cardiologist care among patients with an acute exacerbation of congestive heart failure.

BACKGROUND

Because cardiologist care for acute cardiovascular illness may improve care, barriers to specialty care could impact patient outcomes.

METHODS

We studied 1,298 patients hospitalized with acute exacerbation of congestive heart failure who were cared for by cardiologists or generalist physicians. Using multivariable logistic models we determined factors independently associated with attending cardiologist care.

RESULTS

Patients were less likely to receive care from a cardiologist if they were black (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.35, 0.80), had an income of less than $11,000 (AOR 0.65, 95% CI 0.45, 0.93) or were older than 80 years of age (AOR 0.23, 95% CI 0.12, 0.46). Patients were more likely to receive cardiologist care if they had college level education (AOR 1.89, 95% CI 1.02, 3.51), a history of myocardial infarction (AOR 1.59, 95% CI 1.17, 2.16), a serum sodium less than 133 on admission (AOR 1.96, 95% CI 1.30, 2.95) or a systolic blood pressure less than 90 on admission (AOR 1.97, 95% CI 1.20, 3.24). Patients who stated a desire for life extending care were also more likely to receive care from a cardiologist (AOR 1.40, 95% CI 1.04, 1.90).

CONCLUSIONS

After adjusting for severity of illness and patient preferences for care, patient sociodemographic factors were strongly associated with receiving care from a cardiologist. Future investigations are required to determine whether these associations represent unmeasured preferences for care or inequities in our health care system.

Abbreviations and Acronyms   APACHE = Acute Physiology and Chronic Health Evaluation   APS = Acute Physiology Score   CHF = congestive heart failure   ICU = intensive care unit   LVEF = left ventricular ejection fraction   MI = myocardial infarction   SUPPORT = Study To Understand Prognoses And Preferences For Outcomes And Risks Of Treatments

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