Unstable angina: Specialty‐related disparities in implementation of practice guidelines

Background: The Agency for Health Care Policy and Research (AHCPR) has published practice guidelines to improve the quality of care of patients with unstable angina. Prior to publication, studies demonstrated that when compared with cardiologists, internists were less likely to use effective pharmacologic therapies or revascularization in patients with unstable angina. Hypothesis: The study was undertaken to determine whether the AHCPR guideline publication abolished specialty‐related disparities in care. Methods: We performed a chart review of consecutive patients hospitalized at a university‐affiliated institution with an admission diagnosis of chest pain in the absence of myocardial infarction and a noncardiac etiology. Treatment and diagnostic cardiac testing were compared between risk‐stratified patients cared for by a generalist (n = 125) and those whose care was guided by a cardiologist (n = 211). Results: In those with low‐risk unstable angina, generalists were less likely to prescribe recommended aspirin (71 vs. 88%, p