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Should cardiologists who are not electrophysiologists be inserting implantable cardioverter-defibrillators (ICDs)? Curtis et al. performed a retrospective cohort study of patients who had an ICD fitted between January 2006 and June 2007. Patients were grouped according to whom had implanted their device: electrophysiologists, nonelectrophysiologist cardiologists, thoracic surgeons, and other specialists. The main outcome measures examined were the proportion of patients meeting the criteria for a defibrillator with cardiac resynchronization therapy (CRT-D) who received that device, and the in-hospital procedural complication rates.<\/p>\n
111293 ICD implantations were included in the analysis. Overall, 70.9% were performed by electrophysiologists, 21.9% by nonelectrophysiologist cardiologists, 1.7% by thoracic surgeons, and 5.5% by other specialists. Patients who had an ICD inserted by anyone other than an electrophysiologist were found to be at an increased risk for complications both in unadjusted (p<0.001) and adjusted analyses (relative risk for nonelectrophysiologist cardiologists, 1.11; relative risk for thoracic surgeons, 1.44). Although 35841 patients met criteria for CRT-D, when a nonelectrophysiologist cardiologist or thoracic surgeon performed the procedure, patients were significantly less likely to receive the correct device (relative risk for nonelectrophysiologist cardiologists, 0.93; relative risk for thoracic surgeons, 0.81). The study also demonstrated that electrophysiologists were available in the majority of hospitals where thoracic surgeons and general cardiologist were performing their ICD insertions.<\/p>\n
This study only looked at in-hospital outcomes, and it may be that long-term complications are equally as skewed; the same group is planning longer-term follow-up.Currently, no criteria exist for determining what procedures a physician may or may not perform; this paper demonstrates that this problem will become increasingly important as sub-specialisation in cardiology continues.<\/p>\n
Curtis JP, Luebbert JJ, Wang Y, et al. Association of physician certification and outcomes among patients receiving an implantable cardioverter defibrillator. JAMA 2009; 301:1661-1670.<\/p>\n
Coromilas J. Physician credentials and ICD implantation. JAMA 2009; 301:1713-1174.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
Should cardiologists who are not electrophysiologists be inserting implantable cardioverter-defibrillators (ICDs)? Curtis et al. performed a retrospective cohort study of patients who had an ICD fitted between January 2006 and June 2007. Patients were grouped according to whom had implanted their device: electrophysiologists, nonelectrophysiologist cardiologists, thoracic surgeons, and other specialists. The main outcome measures examined […]<\/p>\n