Study Backs Cardiologists Over Generalists : Medicine: Heart specialists are more likely than family doctors to provide the latest and most aggressive care for heart attacks, researchers say.

Heart specialists are more likely than family doctors to provide the latest and most aggressive kinds of care for heart attacks, the nation’s most common medical emergency, a study concludes.

Its authors question the often-repeated belief that more medical care should be turned over to general doctors. In this case, at least, it appears that greater medical knowledge actually does translate into better care.

In recent years, a variety of research has shown that clot-dissolving drugs and aspirin can reduce the severity of heart attacks. Furthermore, long-term treatment afterward with aspirin and drugs called beta blockers can also save lives.

The new study attempted to see whether these widely accepted practices are actually being followed by doctors who treat heart attacks. It turns out that generally they are, but the chances of getting state-of-the-art care are better if the doctor is a cardiologist.

“For drugs that are clearly shown to benefit patients, cardiologists were more likely to recognize their benefit and to use them in practice,” said Dr. John Z. Ayanian of Harvard Medical School, one of the researchers.

The idea that specialists know more about a specific area of medicine than their generalist colleagues may not seem like a surprise. But until now, there has been little evidence that their expertise leads to healthier patients.

Heart attacks are the nation’s biggest killer. This year, they will strike 1.5 million Americans and kill about one-third of them. Victims are routinely seen by cardiologists in large hospitals, but not necessarily in smaller ones.

The latest study, based on a survey of 1,211 physicians in New York and Texas, was published in the Oct. 27 issue of the New England Journal of Medicine. The doctors compared the approach of cardiologists with that of general internists and family practitioners.

Among the findings:

* 94% of cardiologists said they were very likely to prescribe clot-dissolving drugs for heart attack victims, compared with 82% of internists and 77% of family practitioners.

* About 90% of the general doctors said they would give aspirin, which has become a mainstay of heart attack treatment, compared with nearly all of cardiologists.

* Beta blockers were routinely prescribed by half of the family practitioners, two-thirds of the internists and three-quarters of the cardiologists.

* The generalists were more likely than the specialists to use two drugs that are worthless and perhaps even hazardous for heart-attack patients.

The researchers speculated that although general doctors may know about the newer approaches to heart attack care, they may be reluctant to use them because they fear triggering side effects that they cannot control.

The number of specialists of all kinds has risen dramatically in recent times, while the growth in general doctors has been much slower. Currently about 30% of all U.S. physicians are generalists, compared with 43% 30 years ago.

One of the goals of the failed Clinton Administration’s health care reform was a sharp increase in the proportion of family doctors. Many believe they provide adequate care at lower prices.

Health maintenance organizations and other managed care plans also stress the importance of using general doctors to coordinate care. They routinely limit patients’ freedom to see specialists as a way of keeping down costs.

Dr. Elliot M. Antman said the Harvard study, which he co-authored, suggests this may be bad for the sick.

“If we are not smart enough to protect patients’ access to some of our best physicians,” he wrote, “we will all be losers.”