The likelihood that patients with intermittent caludification will undergo revascularization is highest when those patients are treated by cardiologists and vascular surgeons, even if exercise is the preferred approach, according to research to be presented this week during the American Roentgen Ray Society’s annual meeting in Chicago.
The study was performed at Rhode Island Hospital in Providence, RI. Lead author Tyler Harris, MD and his colleagues extracted all current procedure terminology (CPT) codes for lower extremity vascular noninvasive physiologic studies and for peripheral arterial stent placement and transluminal angioplasty. Six years of data from the Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary Master Files were analyzed by year and physician specialty. Such data spanned six years and was examined over an eight-year time span, from 2000 to 2007.
“We hypothesized that peripheral artery disease (PAD) physiologic testing growth would be greatest among physicians capable of self-referral, and furthermore, that screening growth would be correlated with PAD revascularization growth,” the authors write. “To test these hypotheses, we compared service volume trends for self-referring specialties--vascular surgery, interventional radiology, and cardiology--with a specialty that depends on outside referrals, diagnostic radiology. The latter was defined as a ‘basal’ growth rate responding only to changing patient demographics and medical practice.”
Study results indicate that for non-invasive physiologic testing, cardiology has demonstrated nearly twice the compounded annual growth rate of vascular surgery and radiology. However, in endovascular therapy for PAD, vascular surgery showed the greatest increase, with compounded growth rates more than twice that of cardiology. In contrast, radiology has experienced a net decline in endovascular PAD therapy.
“There has been a marked increase in volume of non-invasive physiologic testing, particularly within cardiology, a self-referring specialty, and this has been associated with tremendous growth in endovascular therapy for peripheral arterial disease,” Harris says. “Prior work has shown the majority of peripheral arterial stenting and angioplasty is performed for patients with intermittent claudication, particularly when performed by cardiologists.”
Harris adds that non-invasive therapies, such as supervised exercise programs, have shown equivalent outcomes when compared to stenting and angioplasty in this population and across multiple trials. Moreover, he notes, the growth demonstrated by the study has occurred in the absence of any major advance in the understanding of morbidity and mortality of peripheral arterial disease.