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Decreasing outpatient cardiac catheterization rates associated with cardiology clinic volume but not with increasing

Eddie Hulten1, Salvatore Carbonaro, Barnett Gibbs

  • 1Cardiology Service, Department of Internal Medicine, Walter Reed Army Medical Center, 6900 Georgia Ave. NW, Washington, DC 20307, USA.

Military Medicine
|August 6, 2010
PubMed

Insights

Cardiac computed tomographic angiography (CTA) use increased, but did not significantly reduce left heart catheterization (LHC) rates. Declining cardiology clinic volume was the main factor influencing LHC rates.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Informatics

Background:

  • Cardiac computed tomographic angiography (CTA) is an accurate noninvasive diagnostic tool for coronary artery disease (CAD).
  • The increasing adoption of CTA raises questions about its impact on traditional invasive procedures like left heart catheterization (LHC).

Purpose of the Study:

  • To investigate the correlation between the increasing utilization of CTA and the rates of LHC.
  • To analyze trends in percutaneous coronary intervention (PCI) and cardiology clinic volumes in relation to CTA adoption.

Main Methods:

  • A retrospective review of outpatient and inpatient electronic medical records was conducted.
  • Data from July 2004 to June 2008 were analyzed, comparing periods before and after CTA implementation.
  • Monthly rates of LHC, PCI, CTA, and cardiology clinic volume were tracked.

Main Results:

  • CTA utilization increased significantly by 64% (p<0.001) after its introduction.
  • Left heart catheterization (LHC) rates showed a non-significant decrease of 20% (p=0.08).
  • Percutaneous coronary intervention (PCI) rates decreased by 47% (p<0.001), while cardiology clinic volume declined by 34%.

Conclusions:

  • Despite increased CTA use, it was not significantly correlated with a reduction in LHC rates.
  • The observed decline in outpatient LHC rates was primarily influenced by a decrease in cardiology clinic volume.
  • Radionuclide myocardial perfusion scan (MPS) usage remained stable during the study period.

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