Caution or stubbornness? Boston docs shun new heart procedure

longwood mapBoston-area docs are known for their reluctance to adopt new procedures. The Washington Post reports that holds true for a new approach to angioplasty. Instead of steering the catheter into the coronary arteries through the groin, some docs go through the wrist.

Questions about the best method of performing cardiac catheterizations, one of the most common procedures in medicine and among the most profitable for hospitals — Medicare reimburses (George Washington University) GWU about $10,600 for an angioplasty involving one stent — reflect some of the issues in the roiling health-care debate. Is the radial approach, which has a steep learning curve, actually superior or largely a fad? Can it cut costs by reducing hospital stays? And if patients are given a choice of catheterization sites, what factors should they consider? …

In Boston, a city brimming with teaching hospitals and interventional cardiologists — heart specialists with advanced training who perform procedures — only a handful of physicians specialize in radial catheterization, said Pinak B. Shah, director of interventional cardiology training at Brigham and Women’s Hospital.

“There’s no data out there to suggest it is worse and growing evidence that it may be better,” said Shah, an assistant professor of medicine at Harvard Medical School, who performs 60 to 70 percent of procedures through the wrist.

Shah said he believes a combination of financial self-interest, the relative paucity of medical devices designed for radial access, resistance by older physicians and the general tendency of doctors to regard patient discomfort as secondary have contributed to under-use of the approach. 



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