Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infarction

J Am Coll Cardiol. 1998 Oct;32(4):885-9. doi: 10.1016/s0735-1097(98)00325-8.


Objectives: We sought to determine the effect of specialty care on in-hospital mortality in patients with acute myocardial infarction.

Background: There has been increasing pressure to limit access to specialists as a method to reduce the cost of health care. There is little known about the effect on outcome of this shift in the care of acutely ill patients.

Methods: We analyzed the data from 30,715 direct hospital admissions for the treatment of acute myocardial infarction in Pennsylvania in 1993. A risk-adjusted in-hospital mortality model was developed in which 12 of 20 clinical variables were significant independent predictors of in-hospital mortality. To determine whether there were factors other than patient risk that significantly influenced in-hospital mortality, multiple logistic regression analysis was performed on physician, hospital and payer variables.

Results: After adjustment for patient characteristics, a multiple logistic regression analysis identified treatment by a cardiologist (odds ratio=0.83 [confidence interval ¿CI¿=0.74 to 0.94] p < 0.003) and physicians treating a high volume of acute myocardial infarction patients (odds ratio=0.89 [CI=0.80 to 0.99] p < 0.03) as independent predictors of lower in-hospital mortality. Treatment by a cardiologist as compared to primary care physicians was also associated with a significantly lower length of stay for both medically treated patients (p < 0.01) and those undergoing revascularization (p < 0.01).

Conclusions: Treatment by a cardiologist is associated with approximately a 17% reduction in hospital mortality in acute myocardial infarction patients. In addition, patients of physicians treating a high volume of patients have approximately an 11% reduction in mortality. This has important implications for the optimal treatment of acute myocardial infarction in the current transformation of the health care delivery system.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cardiology*
  • Female
  • Hospital Mortality*
  • Humans
  • Insurance, Health
  • Male
  • Myocardial Infarction / mortality*
  • Myocardial Infarction / therapy
  • Physicians, Family