Background: Inpatient management of cardiac patients by cardiologists results in reduced mortality and hospitalization. With increasing sub-specialization of the field due to growing management complexity and use of technological innovations, the impact of sub-specialization on patient outcomes is unclear. Purpose: We sought to investigate whether management by subspecialty cardiologists impacts the outcomes of patients with subspecialty specific diseases and if so, whether this is due to clinical expertise or access to technological innovations in care. Methods: All patients admitted to a tertiary centre over nine years with a diagnosis of heart failure, acute coronary syndrome (ACS) or primary arrhythmia were reviewed. The outcomes of these patients managed by cardiologists subspecialized in their admission diagnosis (heart failure specialists, interventionalists, and electrophysiologists) was compared with those treated by general cardiologists. Results: Heart failure was diagnosed in 1,704 patients, ACS in 7,763 and arrhythmia in 4,398. There was no difference in length of stay (LOS) (p=0.26), mortality (p=0.57) or cardiovascular readmissions (p=0.50) in heart failure patients treated by general cardiologists compared with subspecialists. In ACS patients, subspecialty management was associated with reduced LOS, cardiovascular readmissions and mortality (all p<0.05). This reduction in mortality was seen mainly in low risk patients (p<0.05). There was a reduction in LOS and cardiovascular readmissions in arrhythmia patients receiving subspecialty management (both p<0.05), however no difference in mortality (p=0.14). ACS patients managed by interventionalists were more likely to undergo coronary intervention (p<0.05). Electrophysiologists more frequently referred patients for catheter ablation and pacemaker implantation than general cardiologists (p<0.05). Conclusions: The development of healthcare models which align cardiovascular disease with the subspecialist are likely to result in effective utilization of healthcare personnel and the appropriate selection of patients who would benefit from technological innovations in care.
Pathik, M., De Pasquale, C., McGavigan, A., Sinhal, S., Vaile, J., Tideman, P., Bridgman, C., Selvanayagam, J., Heddle, W., & Chew, D. (2015). Sub-specialization in cardiology care and outcome: should clinical services be redesigned, again? European Heart Journal, 36(S1), 630. [P3630]. https://doi.org/10.1093/eurheartj/ehv400