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Hospitals Vary Widely in Rate of Heart Procedures: Study
Date:8/8/2011

r rates of obstructive CAD tended to perform the procedure on lower-risk patients, including those who were younger and had no or atypical symptoms.

Hospitals at the other end of the scale seemed to select their patients more carefully, only performing the procedure on higher-risk patients, such as those with hypertension or diabetes. They also were less likely to prescribe aspirin, beta blockers, blood thinners and statins, and more likely to be low-volume centers, meaning they perform fewer of these procedures.

"When we looked at the average rate of finding obstructive coronary artery disease, we found that all hospitals are not the same," Douglas said. "There is substantial variation."

"That would represent a pattern of care in that particular institution compared to another institution," she added. "It's not just a patient-by-patient decision but decisions determined by the practice or culture in a particular hospital, whether hospitals are more or less aggressive."

Douglas suggests that the guidelines for making decisions on who undergoes this procedure should be tightened.

"There's a need for consensus agreement amongst cardiologists, and some standards as to which kinds of patients should undergo catheterization and which shouldn't," she said.

The American College of Cardiology will issue such criteria later this year, she added.

Dr. John Gassler, a professor of medicine at the University of Rochester Medical Center in New York, finds the study "intriguing" but doesn't feel it answers the question of overuse of diagnostic catheterization.

"There are many factors involved in making this decision," he said.

More information

The U.S. National Library of Medicine has more on cardiac catheterization.

SOURCES: Pamela S. Douglas, M.D., Ursula Geller professor of cardiovascular research, Du
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