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.
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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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