While several studies have suggested that heart attack patients cared for by cardiologists have lower death rates than those treated by other types of physicians, few studies have looked specifically at congestive heart failure. "We thought it was important to study heart failure patients since they have higher mortality rates than those with heart attack," says senior investigator Jack V. Tu, M.D., Ph.D., senior scientist, Institute for Clinical Evaluative Sciences, and associate professor of medicine at the University of Toronto.
The researchers analyzed data on 38,702 Canadian patients with first-time hospitalization for heart failure between April 1994 and March 1996 and who were followed for a year after their initial hospitalization. During their hospital stay, about 14 percent were treated primarily by cardiologists, compared to 35 percent by general internists, 41 percent by family practitioners and nearly 10 percent by other physicians, including respirologists and neurologists.
The study found that patients managed by cardiologists had lower one-year death rates. Their death rate was 28.5 percent compared to 31.7 percent for patients treated by general internists, 34.9 percent for those treated by family practitioners, and 35.9 percent for those treated by other types of physicians.
Part of the reason for the differences in outcomes appears to be that cardiologists are more likely to prescribe medications, such as angiotensin converting enzyme (ACE) inhibitors and beta-blockers, which have been shown to improve heart failure patients' survival, Tu says. The researchers also found that cardiologists were more likely to use invasive interventions, including cardiac catheterization.
Thus, the practice of cardiologists seem to follow published treatment guidelines more closely.
Tu suggests that cardiologists might be more familiar with the latest heart failure literature, while doctors in more general disciplines, such as family medicine, have less time to focus on specialized and complex diseases such as heart failure.
"This study seems to suggest that care that adheres to currently approved guidelines results in better outcomes," says American Heart Association president-elect Augustus Grant, M.D., Ph.D. "It is likely that this benefit could be extended if more care givers – whatever their specialty – utilized these guidelines in the care of their patients."
Although this study examined Canadian data, Tu believes the results can be applied to the United States because U.S. and Canadian physicians have similar training.
"The message is that specialized training leads to better patient outcomes. Still, we encourage all physicians to use the latest evidence-based therapies, especially when it comes to heart failure," he says.
"There are simple things that all physicians can do, including prescribing ACE inhibitors and beta-blockers, to improve patients' outcomes," Tu says.
The message for patients is that they may want to have a cardiologist involved in their care, he adds.
In an accompanying editorial, Daniel H. Kim, M.D., and Sharon A. Hunt, M.D., of Stanford University School of Medicine, Stanford, Calif., write about meshing an interdisciplinary care team for heart failure patients.
"The complexity of heart failure and intricacies of its treatments make it increasingly more challenging to provide optimal patient care without acquiring adequate expertise," says Kim, a cardiologist and a heart failure and heart transplant fellow. "But rather than it being a caregiver issue, it is more an issue of treatment plan. The fundamental issue is not who provides the care but how to best provide the specialized care needed for this complex syndrome. Such a plan may be best devised and implemented by a collaborative, multidisciplinary approach."
Evidence points to the importance of heart failure patients having a complement of people from different disciplines taking care of them. This would include primary care physicians, cardiologists or heart failure specialists, as well as nurse specialists, physiotherapists, social workers and pharmacists, Kim says.
Nearly 5 million Americans are living with congestive heart failure, which is one of the most common reasons that people over age 65 are hospitalized, according to the American Heart Association.
Co-authors are Philip Jong, M.D.; Yanyan Gong, M.Sc.; Peter P. Liu, M.D.; Peter C. Austin, Ph.D. and Douglas S. Lee, M.D.
Contact: For journal copies only,
please call: 214-706-1396
For other information, call:
Bridgette McNeill: 214-706-1135
Julie Del Barto (broadcast): 214-706-1330