Physician Experience Saves More Lives By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC  --Percutaneous coronary intervention (PCI), or so-called a balloon angioplasty and stent implantation, can rapidly restore blood flow in the heart when someone is having a heart attack. When this procedure is used as a first step in the treatment of a heart attack victim, it is usually referred to as “primary PCI”.  Although this procedure is common and generally safe, it can be a bit riskier in sicker heart attack victims with complicated symptoms. Now, an important study has found that physicians and hospitals that do the procedure the most have the lowest death rates.

Using the New York State PCI registry, researchers analyzed data on 7,321 high-risk heart attack patients who had undergone primary PCI at 41 medical centers throughout the state of New York. They found that patients treated in high-volume hospitals, centers performing more than 50 procedures each year, were 42% less likely to die than those treated in low-volume hospitals. And patients treated by experienced physicians, those who had done at least 10 procedures a year, were 34% less likely to die than those treated by their low-volume counterparts.

When both physician and hospital experience were considered together, outcomes were best when high volume physicians were practicing at high volume institutions.  Next best were high volume physicians practicing at low volume hospitals, followed by low volume physicians at high volume hospitals.  Low volumes for both physician and hospital were associated with the worse outcomes.

 “The study confirms what we’ve known for 30 years. That experience is one factor related to outcome,” says James G. Jollis, MD, assistant professor of medicine at Duke University Medical Center in Durham, North Carolina. “When things are going well, almost any team can successfully do angioplasty.  But when complications develop the difference between life and death often depends upon a PCI team that can manage severe complications.”

So what are the implications of these findings?  “At the community level, the results of this study suggest that health care planners who want to improve access to primary angioplasty should consider both hospital and physician volume,” says lead study author V.S. Srinivas, MBBS, an interventional cardiologist at Montefiore Medical Center in New York City. “If introducing new primary angioplasty programs into existing communities will dilute the experience of hospitals and physicians, then alternative approaches such as transferring triage to more experienced centers may be better than developing new centers.”

What should you do?  If you suspect someone is having heart attack, call 911 immediately and go to the nearest hospital, advises Dr. Jollis.  By far the most important factor in determining outcome following a heart attack is how quickly treatment begins.

The study and editorial comment are published in the February 17, 2009 issue of the Journal of the American College of Cardiology. 

Sources:

Srinivas V.S. et al. Effect of Physician Volume on the Relationship Between Hospital Volume and Mortality During Primary Angioplasty.  Journal of the American College of Cardiology, 2009.

Jollis JG.  Editorial Comment: The New York State Primary Angioplasty Registry and Procedural Volume. Journal of the American College of Cardiology, 2009.

V.S. Srinivas, MBBS, Associate Professor of Clinical Medicine and Interventional Cardiologist at Montefiore Medical Center, Bronx, New York.

James G. Jollis, MD, FACC, Assistant Professor of Medicine at Duke University Medical Center in Durham, North Carolina.