The effect of July admission in the process of care of patients with acute cardiovascular conditions

South Med J. 2009 Jun;102(6):602-7. doi: 10.1097/SMJ.0b013e3181a2f8ca.


Background: Little information is available to measure the impact of new trainees in the process of care and outcomes of patients with acute cardiovascular conditions. The objective of this investigation is to assess whether physicians' experience has an impact on the quality of health care delivery.

Methods: Two cohorts of hospitalized patients with acute coronary syndromes (ACS) (n = 764) and decompensated heart failure (HF) (n = 590) were included in this study. Utilization of life-saving medications, diagnostic and therapeutic procedures, and in-hospital outcomes were compared between patients admitted during July-September (J-S) vs. October-June (O-J). Independent predictors of optimal medical management (OMM) were determined by logistic regression analysis.

Results: During O-J, 573 (75%) patients were admitted with an ACS and 516 (84%) with decompensated HF. Among patients with acute coronary syndromes, utilization of beta blockers, aspirin, and statins was similar in the two groups (all P NS). In multivariate analysis, the only independent predictor of optimal medical management was the performance of coronary angioplasty (OR = 1.5, 95% CI = 1.05-2.14, P = 0.02). Among patients with decompensated HF, no difference was found in utilization of beta blockers, ACEI/ARB, length of stay and in-hospital mortality. In multivariate analysis, age >65, atrial fibrillation, admission during J-S, and disease severity were all independent predictors of not receiving optimal medical management (all P < 0.05). These differences were explained exclusively on the basis of EF measurement and not on different utilization rates of pharmacological therapy.

Conclusions: Our results do not support the concept of a "July phenomenon" in patients presenting with acute cardiovascular conditions.

MeSH terms

  • Acute Coronary Syndrome / therapy*
  • Clinical Competence / statistics & numerical data
  • Cohort Studies
  • Female
  • Heart Failure / therapy*
  • Humans
  • Internship and Residency* / standards
  • Internship and Residency* / statistics & numerical data
  • Length of Stay
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Admission / statistics & numerical data
  • Quality of Health Care* / standards
  • Quality of Health Care* / statistics & numerical data
  • Treatment Outcome