COMBINED CARDIAC-CATHETERIZATION FOR UNCOMPLICATED ISCHEMIC-HEART-DISEASE IN A MEDICARE POPULATION

PURPOSE: Experts recommend left heart catheterization alone to evaluat e uncomplicated ischemic heart disease, reserving right heart catheter ization for specific indications. Yet some centers routinely perform c ombined cardiac catheterization (left heart catheterization and right heart catheterization together).SUBJECTS AND METHODS: Using 1992-1993 Pennsylvania Medicare claims for cardiac catheterizations (n = 41,180) , we examined rates of combined cardiac catheterization for patients w ith uncomplicated ischemic heart disease for each hospital (n = 73) th at performed catheterizations. We compared combined cardiac catheteriz ation rates among hospitals and developed a multivariable model to ide ntify hospital characteristics associated with high combined cardiac c atheterization rates. A random sample of cases from the 10 hospitals w ith the highest combined cardiac catheterization rates were reviewed t o determine justification, complications, and results of combined card iac catheterization. RESULTS: Of the 41,180 cardiac catheterizations, 14,177 (34%) were combined procedures. Among hospitals, combined cardi ac catheterization rates varied from 2% to 98%. Hospital characteristi cs associated with high combined cardiac catheterization rates include d having a cardiology fellowship program (relative risk [RR] 1.7, 95% confidence interval [CI] 1.1-2.7), location in eastern Pennsylvania (R R 2.5, 95% CI: 1.8-3.5), and volume of catheterizations performed (RR 0.95, 95% CI: 0.91-0.99/100 procedures). For reviewed cases, the most common justification for combined cardiac catheterization was planned I revascularization (44%),which is not a specific indication. Only 49% of cases had at least one specific indication for right heart cathete rization (range by hospital, 30%-74%). The abnormal findings on the ri ght heart catheterization rarely appeared to change management. CONCLU SION: There is wide variation in the practice of combined cardiac cath eterization, which appears to be related to teaching status and geogra phic location. The most common justification fbr the procedure was pla nned revascularization, which is not one of the specific indications s upported by current literature. (C) 1998 by Excerpta Medica, Inc.