unnecessary left ventriculographies

Many left ventriculographies are unnecessary

APRIL 5, 2012 Reed Miller

Stanford, 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."/.../

Vascular Imaging With Computed Tomography and Magnetic Resonance

Preamble
The granting of clinical staff privileges to physicians is a primary mechanism used by institutions to uphold the quality of care. The Joint Commission on Accreditation of Healthcare Organizations requires that the granting of continuing medical staff privileges be based on assessments of applicants against professional criteria specified in the medical staff bylaws.
Physicians themselves are thus charged with identifying the criteria that constitute professional competence and with evaluating their peers accordingly. Yet, the process of evaluating physicians’ knowledge and competence is often constrained
by the evaluator’s own knowledge and ability to elicit the appropriate information, problems compounded by the growing number of highly specialized procedures for
which privileges are requested.
The American College of Cardiology Foundation (ACCF)/American Heart Association (AHA)/American College of Physicians (ACP) Task Force on Clinical Competence and
Training was formed in 1998 to develop recommendationsfor attaining and maintaining the cognitive and technical skills necessary for the competent performance of a specific cardiovascular service, procedure, or technology. These documents are evidence-based, and where evidence is not available, expert opinion is utilized to formulate recommendations.
Indications and contraindications for specific servicesor procedures are not included in the scope of these documents. Recommendations are intended to assist those who must judge the competence of cardiovascular health care providers entering practice for the first time and/or those who are in practice and are undergoing periodic review of their practice expertise. The assessment of competence is complex
and multidimensional; therefore, isolated recommendations contained herein may not ecessarily be sufficient or appropriate for judging overall competence. The current document addresses competence in vascular imaging for computed tomography (CT) and magnetic resonance (MR) and is authored by representatives of the ACCF, the AHA, the
Society of Atherosclerosis Imaging and Prevention (SAIP), the Society for Cardiovascular Angiography and Interventions (SCAI), the Society of Cardiovascular Computed Tomography (SCCT), the Society for Cardiovascular Magnetic Resonance (SCMR), and the Society for Vascular Medicine and Biology (SVMB).