Circulation. 2007;116:1153-1161
Published online before print August 20, 2007, doi: 10.1161/CIRCULATIONAHA.107.697003
Published online before print August 20, 2007, doi: 10.1161/CIRCULATIONAHA.107.697003
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2007;116:1153-1161.)
© 2007 American Heart Association, Inc.
Health Services and Outcomes Research |
CLINICAL PERSPECTIVE
Previous studies have demonstrated differences in the treatment of patients with acute coronary syndromes by physician specialty, but the impact of cardiology specialty care on contemporary treatment patterns has not been studied. We evaluated 55 994 patients with non–ST-segment elevation acute coronary syndromes (ischemic ST-segment changes and/or positive cardiac markers) included in the CRUSADE Quality Improvement Initiative from January 2001 through September 2003 at 301 tertiary US hospitals with full revascularization capabilities. Approximately two thirds of patients were primarily cared for by a cardiology service, and these patients had lower-risk clinical characteristics and more commonly received guidelines-recommended acute (
24 hours) medications, invasive cardiac procedures, and discharge medications and lifestyle interventions than patients primarily cared for on a noncardiology service. Although the adjusted risk of in-hospital mortality was lower with care provided by a cardiology service, accounting for differences in the use of acute medications and invasive procedures partially attenuated this adjusted mortality difference. The present analysis highlights the difficulties in accurately determining how specialty care is associated with clinical outcomes for patients with acute coronary syndromes and suggests that novel methodologies for evaluating the influence of specialty care on the treatment and outcomes of acute coronary syndrome patients need to be developed.
 |
Footnotes |
|---|
The online-only Data Supplement, consisting of 2 appendices, is available with this article at http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.107.697003/DC1.
This article has been cited by other articles:
 |
|
 |
|
  M. A. Hlatky and P. A. Heidenreich The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., April 21, 2009; 53(16): 1459 - 1466. [Full Text] [PDF]
|
|
|
|
 |
|
 S.-L. T. Normand Some Old and Some New Statistical Tools for Outcomes Research Circulation, August 19, 2008; 118(8): 872 - 884. [Full Text] [PDF]
|
|
|
|
|
|
A. Porath, A. Jotkowitz, and D. Zahger Letter by Porath et al Regarding Article, "Influence of Inpatient Service Specialty on Care Processes and Outcomes for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes" Circulation, February 26, 2008; 117(8): e168 - e168. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||