The purpose of this study was to consider the factors associated with receiving care by a cardiologist in patients experiencing an acute exacerbation of congestive heart failure. Data for this study were drawn from the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment, a prospective multi-center study of care for seriously ill hospitalized adults. This study included patients with a diagnosis of acute exacerbation of congestive heart failure (CHF) whose attending physicians were cardiologists or general internists. The dates of data collection were not reported.

Compared with generalists' patients, cardiologists' patients were younger, more likely to be men, less likely to be black, more likely to have greater than a high school education and an annual income greater than $11,000, and more likely to have private insurance. The median Acute Physiology Score was lower among cardiology patients and serum albumin was higher, but they also had lower systolic blood pressure and lower serum sodium at admission. Of the generalists' patient charts reviewed, 40.5% received a cardiology consultation, and the only factor that was associated with receiving a consultation was annual income greater than $11,000.

The multivariate analysis (which controlled for demographic factors, clinical factors, and SES) found that patients were less likely to receive care from a cardiologist if they had less then 16 years of education; were black; were insured by Medicaid and Medicare, uninsured, or insured by Medicaid alone; received a salary less the $11,000 annually; had 3 or more comorbidities; or were aged 70 year or older. With regard to clinical factors, history of myocardial infarction, low serum sodium, low systolic blood pressure, and preference for life-extending care were all associated with cardiologist care. Additionally, in a subset of the full sample, longitudinal care for the patient was assessed. Whether a patient's physician had cared for them for more than one month was not associated with the likelihood of receiving cardiologist care.

The authors conclude, "having a cardiologist was associated with patient sociodemographic factors even after adjusting for severity of illness, longitudinal care by the physician and preferences for care." They suggest that possible explanations might include physicians' perceptions of patient prognosis, specific referral relationships between providers, or subtleties of patients' prior history that affect referral at the time of hospitalization. "It is also possible that referral to cardiovascular specialty care was solely biased by patient demographics such as race, as has been seen in previous studies." Limitations of this study include use of the SUPPORT patient population – a severely ill, hospitalized population with a poor short-term prognosis.