A study of 220,000 Medicare patients found that heart attack victims are more likely to survive if treated by cardiologists rather than general doctors. The findings, which raise concern about insurance companies' growing reliance on primary care doctors, are published in the Dec. 19 New England Journal of Medicine.
To hold down costs, managed-care insurance plans often require that patients be seen by primary care doctors before being referred to specialists, such as cardiologists. Such programs often include financial incentives to encourage doctors to limit these referrals. In the study, heart attack victims were 12% more likely to be alive a year later if they were admitted to the hospital by a specialist in cardiology rather than a general doctor. The study concluded that specialists were more aggressive in use of up-to-date treatments, especially clot-dissolving drugs that limit heart attack damage.