Despite all the bad press the United States healthcare system gets, there is one incontrovertible truth: we’re the leading authority in cardiac catheterization. If practice makes perfect, no one is closer to perfection than us. Let’s not tarnish our procedural expertise with silly notions of appropriateness, shall we?
These authors from Canada – clearly, with a hometown bias – undertake a retrospective registry review comparing cardiac catheterizations from Ontario and New York state. They observe New York state performs twice as many cardiac catheterizations per capita and wonder – are Americans twice as unhealthy, or are our cardiologists just twice as skilled at profiting from cardiac catheterization?
The review excludes patients known to have obstructive CAD, shock, recent MI, or unstable angina – which makes this essentially an elective cath cohort. Overall, 30.4% of patients in New York were diagnosed with obstructive CAD on catheterization, compared with 44.8% in Ontario. This higher diagnostic yield is unsurprising, considering the New York cohort had, by far, a lower predicted probability of obstructive CAD. This reasonably supports the follow-up author conclusion Ontario does a superior job at selecting patients for the procedure.
I can’t believe they would imply U.S. healthcare delivery is somehow inefficient.
As Outside Hospital notes: We can cath you.
“Prevalence and Extent of Obstructive Coronary Artery Disease Among Patients Undergoing Elective Coronary Catheterization in New York State and Ontario”
www.ncbi.nlm.nih.gov/pubmed/23839750