Abstract
Background: Studies from past decades demonstrate that few articles on end of life issues are published in cardiology journals, compared with other medical specialties. Methods: We searched OvidMEDLINE from January 2001 - August 2012 for end of life articles published in cardiology, critical care, respiratory, geriatrics, general medicine, and oncology journals with impact factor (IF) > 1 according to Journal Citation Reports. To test reliability of defining end of life articles, a separate reviewer re-examined a subset of articles from a randomly selected journal for each specialty. Reviewers were compared using a kappa statistic. To estimate rate ratios for publishing end of life articles, a Poisson regression model was used with indicator variables for journal specialty, and IF as an adjustment covariate. Results: 3741 end of life articles were identified from 391 journals, including 89 cardiology journals. Agreement was good between reviewers (k=0.75). Critical care, general medicine and geriatrics published a higher percentage of end of life articles than cardiology (Rate Ratio [RR] 3.6, 2.5 and 3.7 respectively, p<0.01 for each comparison). Pulmonary and oncology published lower percentages (RR 0.46, p=0.02 and RR 0.68, p=0.08 respectively). Conclusion: Cardiology journals no longer published the lowest percentage of end of life articles among medical specialties. These findings suggest a growing, though still suboptimal, recognition of the importance of end of life care in cardiology.
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