Cardiologists performing peripheral angioplasties: impact on utilization

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Health Services Research

Background:

• Peripheral arterial occlusive disease interventions traditionally performed by radiologists and surgeons.
• Increasing involvement of cardiologists in peripheral angioplasty procedures.
• Uncertainty regarding the impact of cardiologist participation on procedure volume.

Purpose of the Study:

• To examine the relationship between the proportion of peripheral angioplasties performed by cardiologists and population-based angioplasty rates.
• To assess geographic variations in peripheral angioplasty utilization.
• To understand the role of interventional cardiologists in peripheral vascular interventions.

Main Methods:

• Cross-sectional analysis of U.S. Medicare beneficiaries undergoing peripheral angioplasty in 1996.
• Utilized physician claims data for cardiovascular procedures and physician specialty information.
• Calculated procedure rates and the proportion performed by cardiologists across 306 U.S. hospital referral regions (HRRs).

Main Results:

• Over 37,000 peripheral angioplasties were performed; cardiologists accounted for 26% overall and 37% of renal angioplasties.
• Significant geographic variation in peripheral angioplasty use (14-fold range).
• HRRs with ≥50% cardiologist involvement showed nearly double the angioplasty rates compared to those with no cardiologist involvement (21.9 vs. 12.1 per 10,000 beneficiaries; P < 0.001).

Conclusions:

• Cardiologists are performing a substantial volume of peripheral angioplasty procedures.
• Peripheral angioplasty utilization rates are highest in regions with greater cardiologist participation.
• Findings suggest a significant impact of cardiologist involvement on the accessibility and volume of peripheral angioplasty.