Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction

Objectives. We sought to determine the effect of specialty care on in hospital mortality in patients with acute myocardial infarction. Background. There has been increasing pressure to limit access to specialists as a method to reduce the cost of health care. There is little known about the effect on outcome of this shift in the care of acutely ill patients. Methods. We analyzed the data from 30,715 direct hospital admissions for the treatment of acute myocardial infarction in Pennsylvania in 1993, A risk adjusted in-hospital mortality model was developed in which 12 of 20 clinical variables were significant independent predictors of in hospital mortality. To determine whether there were factors other than patient risk that significantly influenced in-hospital mortality, multiple logistic regression analysis was performed on physician, hospital and payer variables. Results. After adjustment for patient characteristics, a multiple logistic regression analysis identified treatment by a cardiologist (odds ratio = 0.83 [confidence interval {CI} = 0.74 to 0.94] p < 0.003) and physicians treating a high volume of acute myocardial infarction patients (odds ratio = 0.89 [CI = 0.80 to 0.99] p < 0.03) as independent predictors of lower in-hospital mortality. Treatment by a cardiologist as compared to primary care physicians was also associated with a significantly lower length of stay for both medically treated patients (p < 0.01) and those undergoing revascularization (p < 0.01). Conclusions. Treatment by a cardiologist is associated with approximately a 17% reduction in hospital mortality in acute myocardial infarction patients. In addition, patients of physicians treating a high volume of patients have approximately an 11% reduction in mortality. This has important implications for the optimal treatment of acute myocardial infarction in the current transformation of the health care delivery system. (C) 1998 by the American College of Cardiology.