Shifting the care of elderly heart attack patients from cardiologists to primary care physicians may be a mistake, caution researchers supported by the Agency for Health Care Policy and Research. They found that elderly heart attack patients who were admitted to a hospital by a cardiologist were 12% less likely to die within 1 year than those admitted by a primary care physician. This survival advantage was partly due to cardiologists' use of more cardiac procedures and medications that are associated with improved survival.
Patients admitted by cardiologists underwent more diagnostic and therapeutic procedures, had longer hospital stays (8 or 9 days instead of 1 week), and received more medications to treat ischemic heart disease than patients treated by physicians in internal medicine, family medicine or general practice. Compared with patients admitted by primary care physicians, those admitted by cardiologists underwent more coronary angiography (49% vs. 18% to 36%), revascularization procedures (22% vs. 7% to 14%), stress testing (14% vs. 9% to 11%), nuclear imaging (19% vs. 7% to 15%), and echocardiography (55% vs. 40% to 52%). Also, 6% more of the patients admitted by cardiologists were considered eligible for thrombolytic therapy.
Health care strategies that shift the care of elderly heart attack patients from cardiologists to primary care physicians may lower resource use and potentially lower costs, but they also may lead to decreased survival, conclude the researchers. The AHCPR-supported Ischemic Heart Disease Patient Outcomes Research Team (PORT), based at Duke University Medical Center, studies detailed clinical data from the Cooperative Cardiovascular Project (CCP) on 8,241 Medicare patients hospitalized for heart attacks from June through December 1992.