Left ventriculography use varies across VA hospitals

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Veterans Affairs (VA) facilities vary in their use of left ventriculography and that variation cannot be explained by patient characteristics, according to a study published online Nov. 5 in Circulation: Cardiovascular Quality and Outcomes.

Researchers led by Paul A. Heidenreich, MD, MS, of the VA Palo Alto Health Care System in Palo Alto, Calif., analyzed data from patients who underwent cardiac catheterization in the VA Health Care System between 2000 and 2009 to determine patient and hospital factors that may contribute to the use of left ventriculography. They also determined how much use of the procedure varied between facilities.

“The purpose of this study was to examine the current use of left ventriculography during cardiac catheterization in the [VA], a healthcare system without financial incentives to perform additional procedures,” the authors explained.

Left ventriculography was performed in 58 percent of the 457,170 cardiac catheterizations. Previous research found that patients insured by private health maintenance organizations who had cardiac catheterizations, on the other hand, had left ventriculographies 85 percent of the time.

In 86 cardiac cath labs, the use of left ventriculography varied between 0.2 percent and 95 percent, which “suggests that variation cannot be explained by patient characteristics or preferences but is instead likely attributable to different opinions on the value of left ventriculography among invasive cardiologists,” the authors explained.

Facility characteristics were also not likely to play much of a role in the variation between facilities. The procedures were less likely to be performed in VA hospitals that belonged to the Council on Teaching Hospitals, contrary to the belief that teaching the procedure is one of the main reasons to perform it.

There were a number of reasons for performing the procedure, including the need for better images, urgency that does not permit waiting for an echocardiogram or other noninvasive procedure and the perception that a left ventriculography is included in a complete cardiac catheterization.

“Clinical guidelines such as appropriateness criteria should be developed to help decrease the variation and limit any overuse of left ventriculography,” the authors concluded.