Differences in outcomes in patients with stable coronary artery disease managed by cardiologists versus noncardiologists Results from the international prospective CLARIFY registry

INTRODUCTION Clinical outcomes of patients with stable coronary artery disease (CAD) may differ between those primarily managed by cardiologists versus noncardiologists. OBJECTIVES Our main objective was to analyze the clinical outcomes of outpatients with stable CAD in relation to the specialty of the managing physicians. PATIENTS AND METHODS We studied 32 468 outpatients with stable CAD included in the CLARIFY registry, with up to 4 years of follow-up data. Cardiologists provided medical care in 84.1% and noncardiologists in 15.9% of the patients. Primary outcome was the composite of cardiovascular death, nonfatal myocardial infarction (MI), or stroke. RESULTS Important differences in management as well as demographic and clinical characteristics were observed between the groups at baseline. Patients treated by cardiologists were younger and more of them had dyslipidemia, hypertension, and diabetes. The use of blockers and thienopyridines, as well as history of percutaneous coronary intervention were more frequent in this group. More patients treated by noncardiologists had a history of MI as well as concomitant peripheral artery disease and asthma or chronic obstructive pulmonary disease. They also had lower left ventricular ejection fraction and more often received lipid-lowering drugs. After adjustment for baseline differences, patients treated by cardiologists had a lower risk of the primary outcome (adjusted hazard ratio, 0.80; 95% confidence interval, 0.68-0.94; P = 0.0067) and of most secondary outcomes, but greater risk of bleeding. CONCLUSIONS Outpatients with stable CAD managed by cardiologists had a lower rate of cardiovascular outcomes than those managed by noncardiologists. We did not find clear evidence that cardiologists provided superior guideline-based treatment, so the differences in outcome were most likely due to unquantifiable differences in patient characteristics