Training matters when it comes to the heart

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When it comes to the "wiring" of the heart it matters who takes care of the patient.

Jeptha Curtis, M.D., of Yale, and colleagues reported in the April 22/29 Journal of the American Medical Association on a study comparing complication rates of surgeons, electrophysiologists, and cardiologists (non-electrophysiologist) who placed pace makers for patients.

Using data from the American College of Cardiology National Cardiovascular Data Registry, the authors analyzed data submitted from January 2006 to June 2007. The data comprise more than 130 elements related to implantable cardioverter-defibrillator (ICDs) implantation, upgrade, and replacement.

Patients were categorized according to the implanting physician's certification: electrophysiologists, nonelectrophysiologist cardiologists, thoracic surgeons, and other specialists. There was a total of 111,293 implantations: 70.9% by electrophysiologists, 21.9% by other cardiologists, 1.7% by thoracic surgeons, and 5.5% by other specialists.

The study found that patients who received ICDs had lower complication rates when electrophysiologists were in charge.

The overall complication rate was 3.7%, which included:

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* 3.5% for electrophysiologists

* 4.0% for other cardiologists

* 4.0% for other specialists

* 5.8% for thoracic surgeons

A limitation of the study was analysis only of complications arising during the initial hospitalization.

In an accompanying editorial, James Coromilas, M.D., of the University of Medicine and Dentistry of New Jersey in New Brunswick, suggests the study provides support for a "compelling argument" that ICD implantation should be performed by a board-certified electrophysiologist whenever possible. It is important that the decision to implant an ICD be a team decision involving the patient’s cardiologist, heart failure expert, and the physician who will implant the device.

Sources:
Curtis JP, et al "Association of physician certification and outcomes among patients receiving an implantable cardioverter-defibrillator" JAMA 2009; 301(16): 1661-70.

Coromilas J "Physician credentials and ICD implantation. Certified 'electricians' best deal with electrical problems" JAMA 2009; 301(16): 1713-14.

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