Is cardiology consultation required before cardiac catheterization?

Background: In many hospitals, internists have begun to directly refer patients for cardiac catheterization without a prior cardiology consultation. The purpose of this study is to compare the results of a policy of mandatory consultation prior to catheterization with one of optional consultation. Methods: One hundred seventy-five consecutive patients who underwent catheterization with a prior cardiology consultation (closed group) were compared to 175 patients who underwent the procedure without a prior mandatory consultation (open group). The primary outcomes were defined as whether significant coronary disease was found and what therapy the patient received. Results: There was no difference in the percentage of patients who were found to have coronary disease in each group (72% in the closed group and 77% in the open group, P=NS), and there was also no difference in the percentage of patients who received revascularization therapy (43% in the closed group and 44% in the open group, P=NS). Conclusions: Allowing internists to refer patients directly for catheterization resulted in equivalent results as compared to requiring cardiology consultation. This study supports the policy of allowing direct referral for catheterization, but further studies are needed to compare the outcomes of cardiac patients cared for by hospitalists without cardiology consultation.