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Coronary arteriography performed by a physician assistant
1Division of Cardiology, Portland Veterans Administration Medical Center, Oregon 97201.
Insights
Physician assistants can safely perform coronary arteriography, matching cardiology fellows' complication rates. This allows decoupling fellowship training from catheterization laboratory workload, addressing physician oversupply and funding issues.
Area of Science:
- Cardiovascular Medicine
- Medical Education
- Interventional Cardiology
Background:
- Cardiology fellowship training faces challenges due to funding constraints and an oversupply of cardiologists.
- Catheterization laboratory workload can be a limiting factor in training, impacting the number of cardiology fellows.
- Investigating alternative healthcare professionals for procedural tasks is crucial for optimizing training programs.
Purpose of the Study:
- To evaluate the feasibility and safety of physician assistants (PAs) performing coronary arteriography.
- To determine if PAs can perform coronary arteriography independently of cardiology fellowship training needs.
- To assess if PAs can help uncouple fellowship training from catheterization laboratory workload.
Main Methods:
- A prospective study involving 150 patients undergoing coronary arteriography performed by a PA.
- Comparison of complication rates, procedure times, and fluoroscopy times between PAs and cardiology fellows.
- Statistical analysis to determine significant differences in procedural outcomes and efficiency.
Main Results:
- No major adverse events (death, myocardial infarction, stroke) occurred in the 150 PA-performed procedures.
- The complication rate for PAs (1.3%) was comparable to that of cardiology fellows (1.3%).
- Procedure and fluoroscopy times were similar, with only preoperative fluoroscopy time showing a statistically significant difference (p = 0.02).
Conclusions:
- Physician assistants can be safely substituted for cardiology fellows in performing coronary arteriography.
- This substitution offers a viable solution for institutions where procedure volume exceeds fellowship training capacity.
- Implementing PAs in this role can help manage workforce challenges and optimize resource utilization in cardiology.
Abstract:
Funding constraints and an oversupply of cardiologists mitigate against continued training of increasing numbers of cardiology fellows. In some institutions, the workload of the catheterization laboratory is an overriding factor. The ability of a physician assistant to perform some of this work was tested to determine if the number of fellows and the content of the fellowship training program could be uncoupled from the catheterization laboratory workload. Among the first 150 patients in whom coronary arteriography was performed by a physician assistant, no patient died or had a myocardial infarction or stroke. Two patients (1.3%) had minor complications: a retinal embolus and an infected puncture site. The complication rate in 150 consecutive cases performed by fellows was also 1.3%, a small myocardial infarction and a transient ischemic attack. Procedure times for the physician assistant and for the fellows were 41 +/- 13 and 44 +/- 18 minutes for preoperative patients and 62 +/- 24 and 70 +/- 20 minutes for postoperative patients. Corresponding fluoroscopy times were 11 +/- 5 and 12 +/- 7 minutes for the preoperative and 22 +/- 12 and 20 +/- 6 for postoperative patients. Only preoperative fluoroscopy times were statistically different (p = 0.02). Thus, substituting a physician assistant for a fellow to perform coronary arteriography is an option in institutions at which the number of studies exceeds the training needs of fellows.