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INTERVENTIONAL CARDIOLOGY IN SWITZERLAND

JOURNAL OF INTERVENTIONAL CARDIOLOGY 1995年第1期8卷 43-49页

作者： KAUFMANN, U MEIER, B UniversityHospital BernSwitzerland.

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Differences between patients with heart failure treated by cardiologists, internists, family physicians, and other physicians: Analysis of a large, statewide database

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AMERICAN HEART JOURNAL 2000年第3期139卷 491-496页

作者： Philbin, EF Jenkins, PL Henry Ford Hosp Sect Heart Failure & Cardiac Transplantat Div Cardiovasc Med Detroit MI 48202 USA Bassett Healthcare Mary Imogene Bassett Res Inst Cooperstown NY USA

Background The management of heart failure (HF) by cardiologists may be better than that of other physicians in that cardiologists' treatment choices more frequently conform with published guidelines and the results of clinical trials. Whether cardiologists' management of HF is more or less cost-effective is up for debate. Methods Information on all 1995 New York state hospital discharges assigned ICD-9-CM codes indicative of HF in the principal diagnosis position was obtained. Demographic and clinical characteristics, process of care, resource utilization, and short-term HF-related outcomes were compared between patients of cardiologists and patients of other physicians. Results A total of 44,926 patients were identified, with 10,506 (23%) receiving care from cardiologists, 28,300 (63%) from internists 4812 (11%) from family practitioners, and 1308 (3%) from other physicians. Patients of cardiologists were younger, more frequently male, and less frequently residents of nursing homes. They were more likely to have associated cardiovascular diagnoses but less likely to have comorbid general medical conditions. Patients of cardiologists were more likely to undergo cardiac catheterization (9%) than those of internists (3%) and family practice (2%) physicians but had similar adjusted hospital length of stay and charges. Mortality and hospital readmission rates for HF were similar among the groups. Patients in the "other" group (managed mostly by surgeons) were the youngest, underwent more invasive and cardiac surgical procedures, and had the longest length of stay and highest hospital charges. Conclusions Cardiologists' management of HF is not economically disadvantageous. The relations among physician specialty, process of care, resource utilization, and clinical outcomes require further study before rational and evidence-based health care staffing recommendations can be formulated.

关键词：心脏病学/经济学心脏病学/统计学和数值数据队列研究共病现象冠心病/流行病学数据库事实型家庭医学/经济学家庭医学/统计学和数值数据心脏导管插入术/利用心脏瓣膜疾病/流行病学医院收费/统计学和数值数据内科学/经济学内科学/统计学和数值数据肾疾病/流行病学住院时间/经济学住院时间/统计学和数值数据肺疾病/流行病学纽约比值比结果评价(卫生保健)/统计学和数值数据医师诊疗模式/统计学和数值数据患病率老年人女(雌)性人类男(雄)性

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Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care

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AMERICAN HEART JOURNAL 2003年第6期145卷 1086-1093页

作者： Ahmed, A Allman, RM Kiefe, CI Person, SD Shaneyfelt, TM Sims, RV Howard, G DeLong, JF Univ Alabama Birmingham Sch Med Dept Med Div Gerontol & Geriatr Med Birmingham AL 35294 USA Univ Alabama Birmingham Sch Med Dept Med Div Gen Internal Med Birmingham AL USA Univ Alabama Birmingham Sch Med Dept Med Div Prevent Med Birmingham AL USA Univ Alabama Birmingham Sch Publ Hlth Dept Epidemiol & Int Hlth Birmingham AL 35294 USA Univ Alabama Birmingham Sch Publ Hlth Dept Biostat Birmingham AL 35294 USA Univ Alabama Birmingham Sch Publ Hlth Ctr Aging Birmingham AL 35294 USA Univ Alabama Birmingham Sch Publ Hlth Ctr Outcomes & Effectiveness Educ & Res Birmingham AL 35294 USA Univ Alabama Birmingham Prime Care Geriatr Heart Failure Clin Birmingham AL 35294 USA VA Med Ctr Geriatr Heart Failure Clin Sect Geriatr Birmingham AL USA VA Med Ctr Geriatr Heart Failure Clin Sect Internal Med Birmingham AL USA VA Med Ctr Ctr Geriatr Res Educ & Clin Birmingham AL USA Alabama Qual Aussrance Fdn Birmingham AL USA

Background The appropriate roles for generalists and cardiologists in the care of patients. with heart failure (HF) are unknown. The objective of this retrospective cohort study was to determine whether consultation between generalists and cardiologists was associated with better quality and outcomes of HF care. Methods We studied left ventricular function evaluation (LVFE) and angiotensin-converting enzyme inhibitor (ACEI) use and 90-day readmission and 90-day mortality rates in patients with HF who were hospitalized. Patient care was categorized into cardiologist (solo), generalist (solo), or consultative cares. The processes and outcomes of care were compared by care category using logistic regression analyses fit with generalized linear mixed models to adjust for hospital-related clustering. Results Of the 1075 patients studied, 13% received cardiologist care, 55% received generalist care, and 32% received consultative care. More patients who received consultative care (75%) received LVFE than patients who received generalist care (36%) and cardiologist care (53%;P < .001). Fewer patients who received solo care (54% each) received ACEI compared with 71% of patients who received consultative care (P < .001). After multivariable adjustment, consultative care was associated with higher odds of LVFE than generalist care (adjusted odds ratio [OR], 6.06;95% CI, 3.97-9.26) or cardiologist care (adjusted OR, 2.96;95% CI, 1.70-5.13) care. Consultation was also associated with higher odds of ACEI use compared with generalist (adjusted OR, 2.42;95% CI, 1.42-4.12) or cardiologist (adjusted OR, 2.32;95% CI, 1.14-4.72) care. Compared with patients who received generalist, care, patients who received consultative care had lower odds of 90-day readmission (adjusted OR, 0.54;95% CI, 0.34-0.86). Conclusion Collaboration between generalists and cardiologists, rather than solo care by either, was associated with better HF processes and outcomes of care.

关键词：年龄分布血管紧张素转换酶抑制药/治疗应用心脏病学/统计学和数值数据家庭医学/统计学和数值数据医院死亡率住院比值比结果与过程评价(卫生保健) 医师诊疗模式转诊和会诊/统计学和数值数据回顾性研究心室功能左老年人老年人 80以上女(雌)性人类男(雄)性

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Self-reported differences between cardiologists and heart failure specialists in the management of chronic heart failure

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AMERICAN HEART JOURNAL 1999年第1期138卷 100-107页

作者： Bello, D Shah, NB Edep, ME Tateo, IM Massie, BM Vet Affairs Med Ctr Cardiol Sect 111C San Francisco CA 94121 USA Univ Calif San Francisco Dept Med San Francisco CA 94143 USA Univ Calif San Francisco Inst Cardiovasc Res San Francisco CA 94143 USA

Background Heart failure (HF) is responsible for considerable mortality morbidity rates and resource utilization. Recently, several studies have reported improved outcomes when patients are managed by special HF clinics, but it is uncertain whether this improvement reflects differences in physician practices or other aspects of the operation of these clinics. Objectives This study was designed to identify differences in HF management practices between general cardiologists and cardiologists specializing in the treatment of patients with HF. Methods A survey examining diagnostic and treatment practices in patients with HF was sent to a sample of cardiologists derived from the American Medical Association Masterfile and to HF specialists who were members of the Society of Transplant Cardiologists or principal investigators in HF trials. Responses were examined in relation to guidelines issued by the Agency for Health care Policy and Research released 9 months previously, Results In general both groups practice in conformity with published guidelines. However, there were important differences between the practice patterns of general cardiologists and HF specialists. For instance, in patients being evaluated for the first time, cardiologists reported using a chest radiograph to assist in the diagnosis more than did HF specialists (47% vs 12%), whereas HF specialists were more likely to use an echocardiogram (73% vs 48%). Both groups were likely to evaluate their patients for ischemia and possible revascularization, even in patients not having angina. However, HF specialists tended to use coronary angiography as the initial diagnostic test, whereas cardiologists were more likely to use stress testing. HF specialists more often used angiotensin-converting enzyme inhibitors as pari of their initial therapy in patients with mild to moderate HF (94% vs 86%) and during maintenance therapy(91% vs 80%). Also, HF specialists were more likely than cardiologists to titrate angiote

关键词：心脏病学/统计学和数值数据病例管理混杂因素(流行病学) 医师诊疗模式/统计学和数值数据问卷调查疾病严重程度指数专门化/统计学和数值数据美国成年人女(雌)性人类男(雄)性中年人

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Cardiac management by pediatricians versus pediatric cardiologists in an inpatient academic center

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AMERICAN HEART JOURNAL 2003年第3期145卷 424-429页

作者： Benun, J Fisher, SD Orav, EJ Schwartz, ML Exil, V Messere, C Lipschultz, SE Univ Rochester Med Ctr Div Pediat Cardiol Rochester NY 14642 USA Boston Med Ctr Dept Pediat Boston MA USA Boston Univ Sch Med Dept Pediat Boston MA 02118 USA Univ Rochester Med Ctr Dept Med Cardiol Unit Rochester NY 14642 USA Brigham & Womens Hosp Dept Med Boston MA 02115 USA Childrens Hosp Dept Cardiol Boston MA 02115 USA Harvard Univ Sch Med Dept Pediat Boston MA 02115 USA Golisano Childrens Hosp Strong Rochester NY USA Univ Rochester Sch Med & Dent Dept Pediat Rochester NY 14642 USA

Background Limited resources;managed care, and advances in technology have led to the suggestion that physicians other than cardiologists be further empowered to perform the initial cardiac evaluation in children with suspected heart disease. To study this strategy, we compared the management decisions of pediatricians with the recommendations of pediatric cardiologists who reviewed the records of the same patients. Methods Sixty-nine patients aged <23 years with suspected heart disease were referred by pediatricians (n = 40) on the inpatient service at Boston Medical Center, for either a cardiology consultation or echocardiography. Two pediatric cardiologists who were blinded to the management decisions and clinical outcomes later reviewed the patient records. Recommendations between the 2 pediatric cardiologist reviewers and the managing pediatricians were compared. Results Pediatricians scheduled significantly fewer cardiology follow-up visits, instituted cardiac medications significantly less often, arranged significantly fewer family meetings to review cardiac findings, and ordered significantly fewer additional cardiac procedures than the pediatric cardiologists. This result was consistent regardless of whether the pediatrician's management decisions were made on the basis of the echocardiogram results only or on the recommendations of a cardiology consultant. The 2 pediatric cardiologist reviewers agreed more often with each. other than either did with the managing pediatricians. Conclusions Pediatricians have different management styles than-pediatric cardiologists for patients with suspected cardiac disease. The effect of these differences on outcome is unknown, and further investigation is warranted.

关键词：医学科学研究中心心脏病学/统计学和数值数据超声心动描记术/统计学和数值数据随访研究心脏缺损先天性/诊断心脏缺损先天性/治疗心脏病/诊断心脏病/治疗心脏杂音/诊断心脏杂音/治疗住院儿科学/统计学和数值数据医师的作用职业家庭关系转诊和会诊/统计学和数值数据青少年成年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性

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INTERVENTIONAL CARDIOLOGY IN SOUTH-AFRICA

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1995年第1期8卷 51-54页

作者： MANGA, P LANDLESS, P DepartmentofCardiology JohannesburgHospitalSouthAfrica.

South Africa is a country in political and cultural flux. Because of the iniquitous system of apartheid inequalities have been perpetuated at all levels including health care. Due to the high prevalence of ischemic heart disease and rheumatic heart disease, coronary angiography, PTCA, intracoronary stenting, and balloon valvuloplasty have become established cardiological procedures in South Africa. However, a new political dispensation promises changes to health care, which will impact on interventional cardiology. With a proposed emphasis on primary health care, resources for tertiary health care will probably be curtailed Thus consideration will have to be given to reducing expenditure by careful review of indications for expensive interventional procedures and developing new ideas to contain costs. This will be the challenge facing cardiologists in a ''New South Africa''.

关键词：心脏病学/统计学和数值数据心脏病学/发展趋势卫生保健提供/组织和管理预测卫生服务/经济学心脏病/流行病学南非/流行病学青少年成年人人类中年人

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INTERVENTIONAL CARDIOLOGY IN CHILE

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1995年第1期8卷 29-32页

作者： ALCAINO, ME ESCOBAR, E DIPRECA HOSP DEPT CARDIOLSANTIAGOCHILE

In Chile the first experiences with cardiac catheterization began very shortly after Forssmann's first studies. Percutaneous coronary balloon angioplasty (PTCA) was first performed in 1982. Despite a progressively great interest and training of physicians in invasive cardiology there are still restrictions in its development. Most private institutions have modern facilities but their caseloads, ever increasing, are still limited because they take care of only 35% of the population. Public institutions are limited because of funding, and some are just developing PTCA. The situation has improved recently because of deals between the private and public systems. Experience with newer devices is even more limited.

关键词：心脏病医疗设施/统计学和数值数据心脏病学/经济学心脏病学/教育心脏病学/统计学和数值数据智利卫生保健费用心脏导管插入术/统计学和数值数据病人遴选人类

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INTERVENTIONAL CARDIOLOGY IN AUSTRALIA

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1995年第1期8卷 55-58页

作者： MAHAR, LJ CardiovascularInvestigationUnit RoyalAdelaideHospitalSouthAustralia.

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INTERVENTIONAL CARDIOLOGY - AN INDIAN PERSPECTIVE

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1995年第1期8卷 39-42页

作者： PADMAVATI, S AllIndiaHeartFoundation NewDelhi.

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INTERVENTIONAL CARDIOLOGY IN IRELAND

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JOURNAL OF INTERVENTIONAL CARDIOLOGY 1995年第1期8卷 19-22页

作者： SUGRUE, DD CODD, MB DepartmentofClinicalCardiology MaterMisericordiaeHospitalUniversityCollegeDublinIreland.

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