Effect of physician specialty on treatment recommendation to patients withcoronary artery disease

Objective: To assess the influence of physician specialty and the way in wh ich patient data are presented in the treatment recommended for patients wi th coronary artery disease. Methods: in a prospective study, 3,628 patients with significant coronary a rtery disease who had been referred to 1 of 10 heart centers in the Netherl ands as possible candidates for either percutaneous transluminal coronary a ngioplasty (PTCA) or coronary artery bypass graft surgery (CABG) were recru ited. Within each center, the recommended treatment is determined by a team consisting of cardiologists only, cardiovascular surgeons only, or cardiol ogists and cardiovascular surgeons (i.e., composite teams). The main outcom e measures are the proportions of patients for whom PTCA, CABG, or noninvas ive (medical): therapy was recommended. Results: Composite teams made 71% of recommendations, surgeon-only teams, 1 2%, and cardiologist-only teams, 17%. Cardiologist-only teams primarily rec ommended patients to PTCA, surgeon-only teams to CABG, while combined teams made more evenly distributed recommendations (p < .001). Although the pati ents discussed by the three types of teams were clinically different, the r ecommendation patterns remained significant after adjusting for these diffe rences (p < .001). For patients with recent myocardial infarction, direct p resentation of the case to the team by the referring cardiologist reduced t he likelihood that CABG would be recommended. Conclusions: The treatment recommended to patients with coronary artery dis ease is affected by the composition of the team providing the recommendatio n. These findings have important implications far clinical decision making for patients with cardiovascular disease.