VARIATION AMONG CARDIOLOGISTS IN THE UTILIZATION OF RIGHT HEART CATHETERIZATION AT TIME OF CORONARY ANGIOGRAPHY

To describe how often a right heart catheterization was performed at t he time of coronary angiography, the patient characteristics that pred icted the use of this procedure, and the variation among cardiologists in the use of this test, we reviewed all cases of coronary angiograph y (n = 1,282) during the first 2 mo of 1993 at two large community hos pitals. Fifty-two percent of the cases received a right heart catheter ization at the time of their coronary angiography, The following chara cteristics were associated with the receipt of a right heart catheteri zation 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, 9 5% CI = 1.44, 4.49), no coronary angioplasty performed at the procedur e (odds ratio = 2.71, 95% CI = 2.12, 3.45), and increased age (odds ra tio = 1.13 per decade, 95% CI = 1.03, 1.25). Of 37 cardiologists who p erformed >10 coronary angiography procedures, the use of right heart c atheterization varied from 10-90%, The cardiologists' practice variati on persisted after adjustment for patient clinical characteristics. Be cause of the high utilization of right heart catheterization at the ti me of coronary angiography and the variation in use among cardiologist s, even when controlling for patient characteristics, the issue of app ropriate indications for this procedure needs to be addressed in a rig orous fashion. (C) 1996 Wiley-Liss, Inc.