Author + information
- Received April 7, 2000
- Revision received July 11, 2000
- Accepted August 18, 2000
- Published online December 1, 2000.
- 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
- ↵*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
The goal of this study was to determine factors associated with receiving cardiologist care among patients with an acute exacerbation of congestive heart failure.
Because cardiologist care for acute cardiovascular illness may improve care, barriers to specialty care could impact patient outcomes.
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.
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).
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.
☆ Supported by the Robert Wood Johnson Foundation.
Presented in abstract form at the annual meeting of the Society of General Internal Medicine, Washington DC, May 1998.
- Received April 7, 2000.
- Revision received July 11, 2000.
- Accepted August 18, 2000.
- American College of Cardiology