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Heart Attack Survival: Specialist Care Counts

Lower death rate when patients see cardiologists

WEDNESDAY, Nov. 20, 2002 (HealthDayNews) -- Your chances of long-term survival after a heart attack are influenced by the kind of doctor you see, a study finds.

Heart attack patients who went to cardiologists were more likely to live for at least two years than those who saw just an internist or family practitioner, says a report on more than 35,000 survivors. Those seen by a cardiologist and an internist or family doctor did even better.

It's a "shared responsibility" between patient and doctor to be sure that someone who has had a heart attack gets the best care, says Dr. John Z. Ayanian, an associate professor of medicine and health care policy at Harvard Medical School and lead author of a report on the study in tomorrow's issue of The New England Journal of Medicine.

"It's important for patients and their family to have this information so they can seek appropriate care," Ayanian says. "It's also important for primary-care physicians and cardiologists to determine which doctors a patient should see."

Ayanian and his colleagues got their data from the Cooperative Cardiovascular Project, a federal evaluation of 225,000 Medicare members who were hospitalized with heart attacks during 1994 and 1995. The two-year death rate for those who saw a cardiologist was 14.6 percent, compared to 18.3 percent for those who saw an internist or family doctor. The death rate was even lower -- 11.1 percent -- for those who saw both a cardiologist and an internist or family practitioner.

Most of the patients who went to a cardiologist tended to be male, young and were more likely to be white, but Ayanian says the difference "probably is not a function of race, gender or age."

"We don't know the exact mechanism of the effect," he adds. "That will be the subject of future research."

Two factors could explain the difference in survival, the journal report says: One is that the effort to match patients was not entirely successful because of subtle differences in such things as the severity of illness, socioeconomic status and the extent of the social support they got. The other is simply that cardiologists provide better care for heart patients. Those patients who saw a cardiologist were more likely to undergo procedures such as bypass surgery and to have exercise testing.

The better survival of people who were treated both by a cardiologist and a family doctor could be explained by better management of other medical problems such as diabetes, Ayanian says.

However, there was one shortcoming common to all doctors, the study finds.

"Many patients, regardless of their physician's specialty, were not receiving effective drugs or relevant counseling, suggesting that substantial opportunities exist for both cardiologists and general physicians to improve their care," the journal report says.

What To Do

For a complete guide to heart attacks, visit the American Heart Association. For information on angina, visit the National Heart, Lung, and Blood Institute.

SOURCES: John Z. Ayanian, M.D., associate professor, medicine and health care policy, Harvard Medical School, Boston; Nov. 21, 2002, The New England Journal of Medicine
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