Hospitalized patients with heart failure who are treated by cardiologists have a better 1-year survival rate, according to an article in the June 24th rapid access issue of Circulation. Differences in medical care between cardiologists and generalists suggest the value of adhering to cardiology practice guidelines with this severely ill population of patients.

Although several studies have found that patients with acute myocardial infarction cared for by cardiologists have better survival rates than patients cared for by other physicians, few researchers before the current study had looked specifically at care for patients with congestive heart failure. “We thought it was important to study heart failure patients since they have higher mortality rates than those with heart attack,” said senior investigator and lead author Jack V. Tu, MD, PhD.

The Canadian team analyzed data on 38,702 patients who had their first hospital admission for heart failure between April 1994 and March 1996 and who were followed for a year afterward. While in the hospital, about 14 percent of patients were treated primarily by a cardiologist compared with 35 percent by physicians in general internal medicine, 41 percent by physicians in family practice, and nearly 10 percent by other physicians include specialists in pulmonary medicine and neurology.

The researchers found that patients whose primary physician was a cardiologist had better survival at 1 year. The mortality rate was 28.5 percent compared with 31.7 percent for patients treated by internists, 34.9 percent for patients treated by family practitioners, and 35.9 percent for patients treated by other physicians.

Analysis of management while in hospital suggests the value of adhering to published practice guidelines. For example, said Tu, cardiologists were more likely to prescribe medications including angiotensin converting enzyme inhibitors and beta-blockers, which have been shown to improve heart failure patients’ survival. Cardiologists were also more likely to use invasive interventions including cardiac catheterization.

“This study seems to suggest that care that adheres to currently approved guidelines results in better outcomes,” says American Heart Association president-elect Augustus Grant, M.D., Ph.D. “It is likely that this benefit could be extended if more care givers ? whatever their specialty ? utilized these guidelines in the care of their patients.”

Although this study examined Canadian data, Tu believes the results can be applied more widely: “The message is that specialized training leads to better patient outcomes. Still, we encourage all physicians to use the latest evidence-based therapies, especially when it comes to heart failure.”

In an accompanying editorial, Daniel H. Kim, M.D., and Sharon A. Hunt, M.D., wrote about creating an interdisciplinary care team for heart failure patients. Kim said, “The complexity of heart failure and intricacies of its treatments make it increasingly more challenging to provide optimal patient care without acquiring adequate expertise, but rather than it being a caregiver issue, it is more an issue of treatment plan. The fundamental issue is not who provides the care but how to best provide the specialized care needed for this complex syndrome. Such a plan may be best devised and implemented by a collaborative, multidisciplinary approach.”

The editorial authors added that evidence points to the importance of heart failure patients having a complement of people from different disciplines taking care of them. Kim said that this approach would include primary care physicians, cardiologists or heart failure specialists, as well as nurse specialists, physiotherapists, social workers and pharmacists.