Murky projections

Demand for cardiology services will grow by 20 percent in the next dozen years, according to a recent projection. Maybe.

Researchers from IHS in Washington, D.C., published an analysis in Health Affairs this month that applied a model that simulates the prevalence of diseases and use of healthcare services by specialty. They were interested in potential changes with the expansion of health insurance through the Affordable Care Act. They determined that cardiology would be among the most sought-after specialties by 2025. Only vascular surgery had a higher projected growth rate, at 31 percent.

The authors added a number of caveats that could change the projection. New treatment options might increase demand. Penalties or incentives to control costs might dampen demand.

Improvements in the cardiovascular health of the overall population also might put a brake on rising demand. This week, the American College of Cardiology and the American Heart Association unveiled four guidelines targeted mostly at primary care physicians to reduce the risk of cardiovascular disease. The prevention guidelines offer a new risk assessment system and take a different approach to cholesterol management, among other things.

The risk assessment model includes stroke and other factors that are expected to broaden the scope of who is at risk, which may widen the pool of candidates for preventive treatments. The cholesterol guidelines replace cutoff numbers for low-density lipoprotein cholesterol with high-intensity and low-intensity approaches. The revision is designed to overcome any propensity to under- and over-treat patients.

These prevention guidelines are described as a bridge or transition as the associations take over tasks that formerly were part of the National Lung, Heart, and Blood Institute’s duties. Expect updates as early as 2014 that incorporate newer evidence.

Ultimately, the goal is to prevent disease by targeting modifiable risk factors. If the expert panels succeed in identifying effective ways to achieve that goal, and primary care physicians and their patients follow the guidelines, then the need for cardiology services should decrease. Maybe.  

Will implementing the new guidelines change outcomes? What do you think? Please let us know.

Candace Stuart

Cardiovascular Business, editor