Coordinated care improves outcomes for MI patients

A large study of elderly heart attack patients finds those treated by both specialists and generalists live longer.

By Susan J. Landers, AMNews staff. Dec. 23/30, 2002.

Washington -- Two heads really are better than one, particularly when one head belongs to a cardiologist and the other to an internist or a family physician.

A study, published in the Nov. 21 New England Journal of Medicine found that outpatient care provided by both a specialist and a generalist to elderly heart attack patients lowered a patient's risk of dying.

The physicians' skills complement each other, said study author John Ayanian, MD, associate professor of medicine and health care policy at Harvard Medical School and a practicing internist at Brigham and Women's Hospital in Boston.

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 chronic illnesses, may explain the success of the combination, said Dr. Ayanian.

The study's finding doesn't surprise Paul Frame, MD, a family physician in Dansville, N.Y.

"The contributions that the primary care physician brings to the table are, perhaps, a more intimate knowledge of the patient and a knowledge and familiarity with all the other things that are going on with that particular patient," he said.

Often patients who have heart attacks have other diagnoses, too, Dr. Frame noted. For example, patients with metabolic syndrome are becoming a huge part of the group that has a coronary problem.

"These people have diabetes that needs to be managed, they have hypertension, they have obesity, frequently they have arthritis because of their obesity. They may have depression and emotional problems." [...]