Patients discharged after hospitalization for myocardial infarction have a better prognosis if cared for by a cardiologist rather than a primary care physician and have the best prognosis if care is managed by both a cardiologist and a primary care physician, according to an article in the November 21st issue of the New England Journal of Medicine.

The researchers examined 1994 and 1995 data on the medical care of more than 35,000 elderly heart attack survivors for three months after hospital discharge--the normal timeframe for such patients to begin seeing physicians for follow-up.

The current study, sponsored by the U.S. Agency for Healthcare Research and Quality, shows that patients cared for by cardiologists on an outpatient basis have a lower risk of death within two years than patients seen only by primary care physicians (14.6 percent versus 18.3 percent). Patients cared for by both a cardiologist and a primary care physician have an even lower risk of dying within two years than those treated solely by a cardiologist (11.1 percent versus 12.1 percent). In these two comparisons, patients in each group were matched to be similar in age, gender, race, and clinical characteristics, and those in the first comparison were relatively sicker --- with a higher risk of death.

According to lead author John Ayanian, M.D., the tests and procedures that cardiologists can provide their patients, such as exercise testing, angiograms, heart bypass surgery, and cardiac rehabilitation, combined with the experience that primary care physicians have in managing common chronic illnesses, may explain the success of this combination

Researchers did not find that the cardiologists' patients used effective cardiac drugs to any significantly greater extent than other patients. In fact, regardless of which type of physician was used for follow-up care, many patients were not prescribed drugs that have been proven effective such as beta-blockers and cholesterol-lowering medications. However, the cardiologists' patients were more likely to undergo major diagnostic and treatment procedures such as angiograms and heart bypass surgery, and this may have contributed to their better outcomes.

The study also found that patients who were less likely to see a cardiologist for follow-up care were those who had major chronic illnesses such as congestive heart failure, diabetes, or lung disease, as well as those who were African American, female, or very elderly.

Patients who underwent major cardiac procedures while hospitalized such as heart bypass surgery were more likely to follow up with a cardiologist after leaving the hospital.