Differences in outcomes in patients with stable coronary artery disease managed by cardiologists versus non-cardiologists: the international prospective CLARIFY registry

Introduction: Clinical outcomes of patients with stable coronary artery disease (SCAD) may differ between those primarily managed by cardiologists versus non-cardiologists. Objectives: Our main objective was to analyze the clinical outcomes of outpatients with SCAD in relation to the specialty of the managing physicians. Patients and methods: We studied 32,468 outpatients with SCAD included in the CLARIFY registry, with up to 4 years follow-up data. Cardiologists provided medical care in 84.1%, and non-cardiologists in 15.9% of patients. Primary outcome was the composite of cardiovascular death, non-fatal myocardial infarction (MI), or stroke. Results: Important differences in demographics, clinical characteristics, and management were observed between groups at baseline. Patients treated by cardiologists were younger, and more had dyslipidemia, hypertension, and diabetes. The use of beta-blockers and thienopyridines, and history of PCI were more frequent in this group. More patients treated by non-cardiologists had a history of MI, and concomitant peripheral artery disease and asthma/chronic obstructive pulmonary disease. They also had a 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 HR 0.80, 95% CI 0.68–0.94; p=0.0067) and most secondary outcomes, but greater risk of bleeding. Conclusions: Outpatients with SCAD managed by cardiologists had a lower rate of cardiovascular outcomes than those managed by non-cardiologists. 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