Key result
Treatment by non-ICARD-certified physicians is linked to ~10% higher in-hospital mortality versus certified physicians.
Why the study?
Does treatment by an interventional cardiology certified physician improve in-hospital outcomes in patients undergoing percutaneous coronary intervention?
Observational (n=510,708)
Yes
Does treatment by an interventional cardiology certified physician improve in-hospital outcomes in patients undergoing percutaneous coronary intervention?
Answers are grounded in this paper and cite their sources.
Physician interventional cardiology certification is associated with slightly lower in-hospital mortality and emergency CABG rates during PCI, but not with differences in bleeding or vascular complications.
BACKGROUND: The value of American Board of Internal Medicine certification has been questioned. We evaluated the Association of Interventional Cardiology certification with in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) in 2010. METHODS AND RESULTS: We identified physicians who performed ≥10 PCIs in 2010 in the CathPCI Registry and determined interventional cardiology (ICARD) certification status using American Board of Internal Medicine data. We compared in-hospital outcomes of patients treated by certified and noncertified physicians using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary end points were all-cause in-hospital mortality and bleeding complications. Secondary end points included emergency coronary artery bypass grafting, vascular complications, and a composite of any adverse outcome. With 510,708 PCI procedures performed by 5175 physicians, case mix and unadjusted outcomes were similar among certified and noncertified physicians. The adjusted risks of in-hospital mortality (odds ratio, 1.10; 95% confidence interval, 1.02-1.19) and emergency coronary artery bypass grafting (odds ratio, 1.32; 95% confidence interval, 1.12-1.56) were higher in the non-ICARD-certified group, but the risks of bleeding and vascular complications and the composite end point were not statistically significantly different between groups. CONCLUSIONS: We did not observe a consistent association between ICARD certification and the outcomes of PCI procedures. Although there was a significantly higher risk of mortality and emergency coronary artery bypass grafting in patients treated by non-ICARD-certified physicians, the risks of vascular complications and bleeding were similar. Our findings suggest that ICARD certification status alone is not a strong predictor of patient outcomes and indicate a need to enhance the value of subspecialty certification.
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Fiorilli et al. (2015) conducted an observational in Percutaneous coronary intervention (n=510,708). Treatment by non-ICARD-certified physicians vs. Treatment by ICARD-certified physicians was evaluated on All-cause in-hospital mortality (OR 1.10, 95% CI 1.02-1.19). Treatment by non-ICARD-certified physicians was associated with a higher adjusted risk of in-hospital mortality compared to treatment by certified physicians.
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