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Variation among cardiologists in the utilization of right heart catheterization at time of coronary angiography
M L Malone1, T K Bajwa, R J Battiola
1Department of Internal Medicine, Sinai Samaritan Medical Center, Milwaukee, WI 53201, USA.
Insights
Right heart catheterization is frequently performed with coronary angiography, especially in older patients with heart conditions. Significant variation exists in its use among cardiologists, regardless of patient factors, highlighting a need for clearer guidelines.
Area of Science:
- Cardiology
- Medical Procedures
- Health Services Research
Background:
- Right heart catheterization (RHC) is an invasive diagnostic procedure.
- Coronary angiography (CAG) is a common procedure to visualize coronary arteries.
- The combined use of RHC and CAG can provide comprehensive hemodynamic and anatomical information.
Purpose of the Study:
- To determine the frequency of RHC performed concurrently with CAG.
- To identify patient characteristics associated with RHC use during CAG.
- To assess practice variation in RHC utilization among cardiologists.
Main Methods:
- Retrospective review of 1,282 CAG cases from two hospitals over two months in 1993.
- Logistic regression analysis to identify predictors of RHC use.
- Analysis of RHC utilization rates across 37 cardiologists performing over 10 CAG procedures.
Main Results:
- 52% of CAG procedures included RHC.
- Predictors for RHC included cardiomyopathy, congestive heart failure, valvular heart disease, absence of coronary angioplasty, and older age.
- Cardiologists' RHC use varied widely (10-90%) and persisted after adjusting for patient characteristics.
Conclusions:
- RHC is frequently utilized during CAG, with specific patient factors influencing its use.
- Significant and unexplained practice variation exists among cardiologists for RHC during CAG.
- The findings underscore the need for evidence-based guidelines on appropriate indications for RHC in the context of CAG.
Abstract:
To describe how often a right heart catheterization was performed at the time of coronary angiography, the patient characteristics that predicted the use of this procedure, and the variation among cardiologists in the use of this test, we reviewed all cases of coronary angiography (n = 1,282) during the first 2 mo of 1993 at two large community hospitals. Fifty-two percent of the cases received a right heart catheterization at the time of their coronary angiography. The following characteristics were associated with the receipt of a right heart catheterization in a logistic regression analysis: cardiomyopathy (odds ratio = 2.59, 95% CI = 1.01, 6.62), congestive heart failure (odds ratio = 2.07, 95% CI = 1.42, 3.01), valvular heart disease (odds ratio = 2.54, 95% CI = 1.44, 4.49), no coronary angioplasty performed at the procedure (odds ratio = 2.71, 95% CI = 2.12, 3.45), and increased age (odds ratio = 1.13 per decade, 95% CI = 1.03, 1.25). Of 37 cardiologists who performed > 10 coronary angiography procedures, the use of right heart catheterization varied from 10-90%. The cardiologists' practice variation persisted after adjustment for patient clinical characteristics. Because of the high utilization of right heart catheterization at the time of coronary angiography and the variation in use among cardiologists, even when controlling for patient characteristics, the issue of appropriate indications for this procedure needs to be addressed in a rigorous fashion.