Cardiac care is more intense in hospitals, study finds

Heart patients were more likely to receive a high-intensity, hospital-based intervention when their doctor was employed by a hospital compared to patients whose care was managed by an independent cardiologist, a study published Monday in Health Affairs found.

Why it matters: The study signals more evidence that hospital consolidation may lead to more risky — and costly — care.

What they're saying: "Cardiologists order lucrative services that, if kept in-house, contribute to hospitals' financial performance," the authors, led by Northeastern University, wrote in the study.

• "Given that cardiovascular disease costs more than $200 billion and accounts for 660,000 deaths in the U.S. each year, it is critical to understand how patient care may be changing with the rapid reorganization of the country's cardiology professionals," they wrote.

The big picture: Previous studies have shown patients of hospital-integrated oncologists received costlier drugs and that patients of integrated primary care physicians were more likely to receive inappropriate imaging.

Zoom in: Researchers looked at more than 14,000 Medicare claims data between 2013 and 2020 to identify patients with a new diagnosis of "stable angina," a common cardiovascular condition that allows clinical discretion when it comes to treatment.

• There was no evidence, they said, that patients of hospital-integrated cardiologists had more severe illness.
• The researchers looked at how patients whose care was managed by a hospital-integrated cardiologist differed from those whose care was managed by an independent cardiologist.

What they found: Patients who were seen by a hospital-integrated cardiologist were no more likely to get the office-based, diagnostic stress tests within a year of diagnosis.

• However, the patients seen by hospital-integrated cardiologists were more likely to receive high-intensity, hospital-based interventions such as cardiac catheterization (38% vs. 33%) and coronary angioplasties (14% vs. 11%).

The bottom line: The researchers said the results raise the question of why treatment changes may occur among hospital-integrated doctors.

• "These changes could simply reflect employees playing to the strengths of their organization: Those in higher-tech settings can and do perform higher-tech services, especially when treating conditions that offer latitude in clinical decision-making," the authors wrote.
• But, they said: "Whether this is a net good for patients remains unclear."