Heart Failure Patients Do Better When Treated By Cardiologists

	August 13, 1999 - Hospitalized CHF patients treated by
cardiologists are less likely to be readmitted to the hospital and
have better quality of life than those treated by other types of
doctors, according to a new study. Researchers reported their
findings in the August issue of the journal, CHEST.
	Diuretics and digoxin have long been the most common drugs
used to control heart failure. Within the past decade however, major
trials have shown that ACE inhibitors can help CHF patients have
longer, more active lives. They also help heart function by easing
the load on a failing heart.
	Authors of the study said that many of the new CHF treatments
require the expertise of CHF specialists. At the same time, they note
that managed care plans are *increasing* the role of primary care
physicians in CHF treatment.
	This study involved 2,454 patients at 10 community hospitals
in 3 groups:
1) patients not treated by a cardiologist
2) patients whose attending doctor was a cardiologist
3) patients who had consultation from a cardiologist but whose
attending doctor was not a cardiologist.
	All patients were measured in 4 outcomes:
1) length of hospital stay
2) mortality
3) readmission to the hospital
4) quality of life
	Patients who survived their hospital stay were followed for 6
months. In addition to outcomes, researchers also analyzed treatment.
For example, those patients treated by a cardiologist or who had a
consult by a cardiologist were much more likely to have the cause of
their CHF documented in their charts. They were also more likely to
have echocardiograms or MUGAs, and they were more likely to get diet
counseling and disease management strategies. These patients were also
more likely to get ACE inhibitors prescribed.
	Lead author Edward Philbin said that when compared to treatment
by non-cardiologists, direct care by cardiologists meant lower risk of
readmission for CHF and a better quality of life. However, hospital
charges were higher and there was little difference in mortality rates
and length of hospital stay.
	Dr. Philbin said, "Since half of all CHF patients get their
care in non-teaching hospitals, the implications of this study are not
trivial. It is not known whether more rigorous compliance by non-
cardiologists with published guidelines would help."