Predictors of Cardiology Care for Older Patients Hospitalized
Background: Studies have suggested that cardiologists may provide higher quality heart failure care than generalists. However, national rates of specialty care during hospitalization for heart failure and factors associated with care by a cardiologist are unknown.
Methods: We assessed specialty care in a sample of Medicare patients hospitalized nationwide with heart failure between 1998 and 1999 (n = 25,869). Multivariable hierarchical logistic regression models were used to identify factors independently associated with treatment by a cardiologist.
Results: One-quarter (25.5%) of patients had a cardiologist as their attending physician, 31.3% of patients received a cardiology consult, and 43.2% of patients were not treated by a cardiologist during hospitalization. Older patients (age <75 years: referent; age 75-84 years: risk ratio [RR], 0.92; 95% CI, 0.86-0.98; age ≥85 years: RR, 0.81; 95% CI, 0.74-0.88) and women (RR, 0.87; 95% CI, 0.83-0.93) were less likely to have an attending cardiologist. Patients with a history of heart failure (RR, 1.13; 95% CI, 1.06-1.20), coronary disease (RR, 1.23; 95% CI, 1.14-1.32), coronary artery bypass grafting (RR, 1.42; 95% CI, 1.32-1.42), or percutaneous transluminal coronary angioplasty (RR, 1.30; 95% CI, 1.19-1.42) were more likely to be treated by a cardiologist, whereas patients with chronic obstructive pulmonary disease (RR, 0.74; 95% CI, 0.70-0.79) and dementia (RR, 0.61; 95% CI, 0.54-0.70) were less likely to be treated by a cardiologist. Patient race was not associated with treatment by a cardiologist. The strongest predictors of attending cardiology care were hospital factors, including large volume (>300 beds; RR, 1.45; 95% CI, 1.32-1.42) and geographic location (RR, 1.00 Northeast (referent) vs RR, 0.55; 95% CI 0.46-0.65 Midwest).
Conclusions: Slightly more than half of older patients with heart failure received care from a cardiologist. Several patient characteristics, including age and sex, were associated with the use of specialty care, suggesting that factors other than clinical presentation may independently influence the use of specialty care.
Current American College of Cardiology/American Heart Association heart failure guidelines suggest that the use of cardiovascular specialists in the treatment of patients with heart failure may improve guideline adherence and reduce rehospitalization rates. Although more than 1 million patients are hospitalized for heart failure each year, there are limited data about the proportion of patients who are treated by a cardiologist or receive a cardiology consultation during their hospitalization. In addition, it is not known whether patients with specific clinical or demographic characteristics are more or less likely to be treated by a cardiologist than a generalist physician. Of particular concern are elderly patients, women, and members of racial and ethnic minority groups, who have historically had limited access to specialty cardiovascular care. Understanding the characteristics associated with specialty care is also an important prerequisite for evaluating the quality of heart failure care of providers from different specialties.
Accordingly, we evaluated the use of cardiology specialty care in a contemporary cohort of elderly patients who were hospitalized with heart failure. Using data from a nationally representative, community-based sample of Medicare beneficiaries who were hospitalized with heart failure in 1998 to 1999, we sought to determine the proportion of patients who were treated by a cardiologist during hospitalization and to identify patient characteristics correlated with cardiologist treatment, focusing specifically on of the role of patient age, sex, race, and comorbid conditions. We hypothesized that that older age, female sex, black race, and greater comorbidity would reduce the likelihood of receiving not only attending but also consulting cardiology care.
Background: Studies have suggested that cardiologists may provide higher quality heart failure care than generalists. However, national rates of specialty care during hospitalization for heart failure and factors associated with care by a cardiologist are unknown.
Methods: We assessed specialty care in a sample of Medicare patients hospitalized nationwide with heart failure between 1998 and 1999 (n = 25,869). Multivariable hierarchical logistic regression models were used to identify factors independently associated with treatment by a cardiologist.
Results: One-quarter (25.5%) of patients had a cardiologist as their attending physician, 31.3% of patients received a cardiology consult, and 43.2% of patients were not treated by a cardiologist during hospitalization. Older patients (age <75 years: referent; age 75-84 years: risk ratio [RR], 0.92; 95% CI, 0.86-0.98; age ≥85 years: RR, 0.81; 95% CI, 0.74-0.88) and women (RR, 0.87; 95% CI, 0.83-0.93) were less likely to have an attending cardiologist. Patients with a history of heart failure (RR, 1.13; 95% CI, 1.06-1.20), coronary disease (RR, 1.23; 95% CI, 1.14-1.32), coronary artery bypass grafting (RR, 1.42; 95% CI, 1.32-1.42), or percutaneous transluminal coronary angioplasty (RR, 1.30; 95% CI, 1.19-1.42) were more likely to be treated by a cardiologist, whereas patients with chronic obstructive pulmonary disease (RR, 0.74; 95% CI, 0.70-0.79) and dementia (RR, 0.61; 95% CI, 0.54-0.70) were less likely to be treated by a cardiologist. Patient race was not associated with treatment by a cardiologist. The strongest predictors of attending cardiology care were hospital factors, including large volume (>300 beds; RR, 1.45; 95% CI, 1.32-1.42) and geographic location (RR, 1.00 Northeast (referent) vs RR, 0.55; 95% CI 0.46-0.65 Midwest).
Conclusions: Slightly more than half of older patients with heart failure received care from a cardiologist. Several patient characteristics, including age and sex, were associated with the use of specialty care, suggesting that factors other than clinical presentation may independently influence the use of specialty care.
Current American College of Cardiology/American Heart Association heart failure guidelines suggest that the use of cardiovascular specialists in the treatment of patients with heart failure may improve guideline adherence and reduce rehospitalization rates. Although more than 1 million patients are hospitalized for heart failure each year, there are limited data about the proportion of patients who are treated by a cardiologist or receive a cardiology consultation during their hospitalization. In addition, it is not known whether patients with specific clinical or demographic characteristics are more or less likely to be treated by a cardiologist than a generalist physician. Of particular concern are elderly patients, women, and members of racial and ethnic minority groups, who have historically had limited access to specialty cardiovascular care. Understanding the characteristics associated with specialty care is also an important prerequisite for evaluating the quality of heart failure care of providers from different specialties.
Accordingly, we evaluated the use of cardiology specialty care in a contemporary cohort of elderly patients who were hospitalized with heart failure. Using data from a nationally representative, community-based sample of Medicare beneficiaries who were hospitalized with heart failure in 1998 to 1999, we sought to determine the proportion of patients who were treated by a cardiologist during hospitalization and to identify patient characteristics correlated with cardiologist treatment, focusing specifically on of the role of patient age, sex, race, and comorbid conditions. We hypothesized that that older age, female sex, black race, and greater comorbidity would reduce the likelihood of receiving not only attending but also consulting cardiology care.
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