Physician recommendations for coronary revascularization - Variations by clinical speciality

Background: Studies have shown that clinical speciality has a strong influe nce on appropriateness ratings. We examined the effect of clinical speciali ty on physician recommendations for the performance of coronary artery bypa ss graft surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA) in Spain. Methods: Following the RAND appropriateness method, a 10-m ember multispeciality panel composed of cardiovascular surgeons (CVs), inte rventional cardiologists (ICs), and non-interventional cardiologists (NICs) rated the appropriateness of 1826 hypothetical indications: 936 for corona ry revascularization and 890 for preference between PTCA and CABG. For all revascularization indications and for all PTCA-CABG indications for which r evascularization was rated appropriate by the panel, we calculated the mean appropriateness rating, by panellist and by speciality group, and the prop ortion of indications rated with preference for PTCA, with preference for C ABG, and with no preference, by speciality group. Results: The ICs had a hi gher mean rating across ail revascularization indications (7.8) than either the NICs (5.7) or the CVs (5.9). For the 509 indications rated appropriate for revascularization by the panel, the ICs preferred PTCA in 54% of indic ations, versus 39% for the NICs and 25% for the CVs. The CVs preferred CABG in 58% of indications, versus 32% for the NICs and 20% for the ICs. Conclu sions: Appropriateness ratings varied by clinical speciality. Physicians wh o perform a procedure may be more aggressive in recommending its use than n on-performers. Appropriateness panels should be multidisciplinary to accura tely reflect the judgements of the different types of physicians involved i n patient care.