Cardiologist versus internist management of patients with unstable angina: Treatment patterns and outcomes
This study sought to assess the impact of generalist versus specialist direction on the pattern of care and outcome in patients admitted to the hospital for unstable angina. Physicians trained as internists or as cardiologists may have different approaches to treating patients with unstable angina....
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Published in | Journal of the American College of Cardiology Vol. 26; no. 3; pp. 577 - 582 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
01.09.1995
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Abstract | This study sought to assess the impact of generalist versus specialist direction on the pattern of care and outcome in patients admitted to the hospital for unstable angina.
Physicians trained as internists or as cardiologists may have different approaches to treating patients with unstable angina.
We reviewed a prospectively collected cohort of patients discharged with a diagnosis-related group (DRG) diagnosis of unstable angina from William Beaumont Hospital, a large community-based hospital in southeast Michigan. Of 890 consecutive patients, 225 were treated by internists and 665 by cardiologists. We compared these two groups with respect to patterns of use of established pharmacotherapies for unstable angina, diagnostic testing and clinical outcome.
Patients treated by internists less often had a previous cardiac history (53% vs. 80%, p ≤ 0.0001). Internists were less likely to use aspirin (68% vs. 78%, p = 0.032), heparin (67% vs. 84%, p ≤ 0.001) or beta-adrenergic blocking agents (18% vs. 30%, p ≤ 0.004) in their initial management. Exercise tests were performed more frequently by internist-treated patients (37% vs. 22%, p ≤ 0.001), but catheterization (27% vs. 61%, p ≤ 0.0001) and angioplasty (7% vs. 40%, p ≤ 0.0001) were utilized less frequently. The incidence of myocardial infarction was similar (11% vs. 9%) in the two groups, but the mortality rate tended to be higher (4.0% vs. 1.8%, p = 0.06) in the internist group.
Patients with unstable angina treated by internists were less likely to receive effective medical therapy or revascularization procedures and experienced a trend to poorer outcome. This study does not support a positive gatekeeper role for generalists in the treatment of unstable angina. |
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AbstractList | This study sought to assess the impact of generalist versus specialist direction on the pattern of care and outcome in patients admitted to the hospital for unstable angina.
Physicians trained as internists or as cardiologists may have different approaches to treating patients with unstable angina.
We reviewed a prospectively collected cohort of patients discharged with a diagnosis-related group (DRG) diagnosis of unstable angina from William Beaumont Hospital, a large community-based hospital in southeast Michigan. Of 890 consecutive patients, 225 were treated by internists and 665 by cardiologists. We compared these two groups with respect to patterns of use of established pharmacotherapies for unstable angina, diagnostic testing and clinical outcome.
Patients treated by internists less often had a previous cardiac history (53% vs. 80%, p < or = 0.0001). Internists were less likely to use aspirin (68% vs. 78%, p = 0.032), heparin (67% vs. 84%, p < or = 0.001) or beta-adrenergic blocking agents (18% vs. 30%, p < or = 0.004) in their initial management. Exercise tests were performed more frequently by internist-treated patients (37% vs. 22%, p < or = 0.001), but catheterization (27% vs. 61%, p < or = 0.0001) and angioplasty (7% vs. 40%, p < or = 0.0001) were utilized less frequently. The incidence of myocardial infarction was similar (11% vs. 9%) in the two groups, but the mortality rate tended to be higher (4.0% vs. 1.8%, p = 0.06) in the internist group.
Patients with unstable angina treated by internists were less likely to receive effective medical therapy or revascularization procedures and experienced a trend to poorer outcome. This study does not support a positive gatekeeper role for generalists in the treatment of unstable angina. This study sought to assess the impact of generalist versus specialist direction on the pattern of care and outcome in patients admitted to the hospital for unstable angina. Physicians trained as internists or as cardiologists may have different approaches to treating patients with unstable angina. We reviewed a prospectively collected cohort of patients discharged with a diagnosis-related group (DRG) diagnosis of unstable angina from William Beaumont Hospital, a large community-based hospital in southeast Michigan. Of 890 consecutive patients, 225 were treated by internists and 665 by cardiologists. We compared these two groups with respect to patterns of use of established pharmacotherapies for unstable angina, diagnostic testing and clinical outcome. Patients treated by internists less often had a previous cardiac history (53% vs. 80%, p ≤ 0.0001). Internists were less likely to use aspirin (68% vs. 78%, p = 0.032), heparin (67% vs. 84%, p ≤ 0.001) or beta-adrenergic blocking agents (18% vs. 30%, p ≤ 0.004) in their initial management. Exercise tests were performed more frequently by internist-treated patients (37% vs. 22%, p ≤ 0.001), but catheterization (27% vs. 61%, p ≤ 0.0001) and angioplasty (7% vs. 40%, p ≤ 0.0001) were utilized less frequently. The incidence of myocardial infarction was similar (11% vs. 9%) in the two groups, but the mortality rate tended to be higher (4.0% vs. 1.8%, p = 0.06) in the internist group. Patients with unstable angina treated by internists were less likely to receive effective medical therapy or revascularization procedures and experienced a trend to poorer outcome. This study does not support a positive gatekeeper role for generalists in the treatment of unstable angina. OBJECTIVESThis study sought to assess the impact of generalist versus specialist direction on the pattern of care and outcome in patients admitted to the hospital for unstable angina.BACKGROUNDPhysicians trained as internists or as cardiologists may have different approaches to treating patients with unstable angina.METHODSWe reviewed a prospectively collected cohort of patients discharged with a diagnosis-related group (DRG) diagnosis of unstable angina from William Beaumont Hospital, a large community-based hospital in southeast Michigan. Of 890 consecutive patients, 225 were treated by internists and 665 by cardiologists. We compared these two groups with respect to patterns of use of established pharmacotherapies for unstable angina, diagnostic testing and clinical outcome.RESULTSPatients treated by internists less often had a previous cardiac history (53% vs. 80%, p < or = 0.0001). Internists were less likely to use aspirin (68% vs. 78%, p = 0.032), heparin (67% vs. 84%, p < or = 0.001) or beta-adrenergic blocking agents (18% vs. 30%, p < or = 0.004) in their initial management. Exercise tests were performed more frequently by internist-treated patients (37% vs. 22%, p < or = 0.001), but catheterization (27% vs. 61%, p < or = 0.0001) and angioplasty (7% vs. 40%, p < or = 0.0001) were utilized less frequently. The incidence of myocardial infarction was similar (11% vs. 9%) in the two groups, but the mortality rate tended to be higher (4.0% vs. 1.8%, p = 0.06) in the internist group.CONCLUSIONSPatients with unstable angina treated by internists were less likely to receive effective medical therapy or revascularization procedures and experienced a trend to poorer outcome. This study does not support a positive gatekeeper role for generalists in the treatment of unstable angina. |
Author | Schreiber, Theodore L. Elkhatib, Abbas Grines, Cindy L. O'Neill, William W. |
Author_xml | – sequence: 1 givenname: Theodore L. surname: Schreiber fullname: Schreiber, Theodore L. – sequence: 2 givenname: Abbas surname: Elkhatib fullname: Elkhatib, Abbas – sequence: 3 givenname: Cindy L. surname: Grines fullname: Grines, Cindy L. – sequence: 4 givenname: William W. surname: O'Neill fullname: O'Neill, William W. |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/7642845$$D View this record in MEDLINE/PubMed |
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SubjectTerms | Aged Angina, Unstable - diagnosis Angina, Unstable - drug therapy Angina, Unstable - economics Angina, Unstable - mortality Cardiology - economics Cardiology - standards Cardiology - statistics & numerical data Chi-Square Distribution Cohort Studies Diagnosis-Related Groups Female Hospitalization - economics Hospitalization - statistics & numerical data Hospitals, Community - economics Hospitals, Community - statistics & numerical data Humans Internal Medicine - economics Internal Medicine - standards Internal Medicine - statistics & numerical data Male Michigan - epidemiology Middle Aged Outcome Assessment (Health Care) Practice Guidelines as Topic Practice Patterns, Physicians' - economics Practice Patterns, Physicians' - statistics & numerical data Prospective Studies Retrospective Studies |
Title | Cardiologist versus internist management of patients with unstable angina: Treatment patterns and outcomes |
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