Evidence map›Paper›PMID 26475298›Full record

ArticleJournal of the American Heart Association2015

Differences Among Cardiologists in Rates of Positive Coronary Angiograms.

Jason H Wasfy, Michael K Hidrue, Robert W Yeh, Katrina Armstrong, G William Dec, Eugene V Pomerantsev, Michael A Fifer, Timothy G Ferris

Open access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the American Heart Association, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.4field-weighted citation impact, top 31% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 3 citations in OpenAlex.

  1. Article
  2. Article
  3. Differences Among Cardiologists in Rates of Positive Coronary Angiograms.Journal of the American Heart Association · 2015
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Jason H WasfyMassachusetts General Physicians Organization, Harvard Medical School, Boston, MA (J.H.W., M.K.H., T.G.F.) Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., R.W.Y., W.D., E.V.P., M.A.F.).
Michael K HidrueMassachusetts General Physicians Organization, Harvard Medical School, Boston, MA (J.H.W., M.K.H., T.G.F.).
Robert W YehCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., R.W.Y., W.D., E.V.P., M.A.F.).
Katrina ArmstrongDepartment of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (K.A., T.G.F.).
G William DecCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., R.W.Y., W.D., E.V.P., M.A.F.).
Eugene V PomerantsevCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., R.W.Y., W.D., E.V.P., M.A.F.).
Michael A FiferCardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (J.H.W., R.W.Y., W.D., E.V.P., M.A.F.).
Timothy G FerrisMassachusetts General Physicians Organization, Harvard Medical School, Boston, MA (J.H.W., M.K.H., T.G.F.) Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (K.A., T.G.F.) Partners Healthcare, Boston, MA (T.G.F.).
Harvard University · USMassachusetts General Hospital · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundUnderstanding the sources of variation for high-cost services has the potential to improve both patient outcomes and value in health care delivery. Nationally, the overall diagnostic yield of coronary angiography is relatively low, suggesting overutilization. Understanding how individual cardiologists request catheterization may suggest opportunities for improving quality and value. We aimed to assess and explain variation in positive angiograms among referring cardiologists. METHODS AND

resultsWe identified all cases of diagnostic coronary angiography at Massachusetts General Hospital from January 1, 2012, to June 30, 2013. We excluded angiograms for acute coronary syndrome. For each angiogram, we identified clinical features of the patients and characteristics of the requesting cardiologists. We also identified angiogram positivity, defined as at least 1 epicardial coronary stenosis ≥50% luminal narrowing. We then constructed a series of mixed-effects logistic regression models to analyze predictors of positive coronary angiograms. We assessed variation by physician in the models with median odds ratios. Over this time period, 5015 angiograms were identified. We excluded angiograms ordered by cardiologists requesting <10 angiograms. Among the remaining 2925 angiograms, 1450 (49.6%) were positive. Significant predictors of positive angiograms included age, male patients, and peripheral arterial disease. After adjustment for clinical variables only, the median odds ratio was 1.23 (95% CI 1.0-1.36), consistent with only borderline clinical variation after adjustment. In the full clinical and nonclinical model, the median odds ratio was 1.07 (95% CI 1.07-1.20), also consistent with clinically insignificant variation.

conclusionsSubstantial variation exists among requesting cardiologists with respect to positive and negative coronary angiograms. After adjustment for clinical variables, there was only borderline clinically significant variation. These results emphasize the importance of risk adjustment in reporting related to quality and value.

Indexed as

BostonCoronary AngiographyCoronary Artery DiseaseCoronary VesselsFemaleHospitals, GeneralHumansLogistic ModelsMaleObserver VariationOdds RatioPractice Patterns, Physicians'Predictive Value of TestsReferral and ConsultationReproducibility of ResultsRisk Factorscoronary angiographyoutcomes researchvariation analysis

Identifiers

PMID26475298
PMCPMC4845144
OpenAlexW2175767312

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.