Many left ventriculographies are unnecessary
APRIL 5, 2012Stanford, CA - Left ventriculography is performed in most coronary angiography cases, even when the same information has already been obtained noninvasively, a study of Aetna health benefit claims shows [1].
Dr Ronald Witteles (Stanford University, CA) and colleagues retrospectively analyzed claims data from 96 235 patients who underwent angiography in 2007. They found that left ventriculography was performed in 81.8% of cases and that, in 88% of those cases, the test was probably unnecessary because the patient had undergone a LV ejection assessment within the previous 30 days and there was no reason to expect their LV volume or ejection fraction had changed since that test. Results of the study have been published in the American Heart Journal.
"We observed the seemingly very arbitrary nature of which patients would get a left ventriculogram and which wouldn't. And we would see patients who had had recent alternative assessments of their ejection fractions already done getting the left ventriculogram as a routine add-on procedure. This didn't [make sense] to us from any standpoint—patient care or ethical—so we all felt compelled to investigate it further," Witteles told heartwire. He said that, based on an informal survey of his colleagues, he expected the percentage of apparently extraneous ventriculographies to be around 20%, so when the data showed it was near 90%, it was "shocking."/.../
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