Board Certification in Interventional Cardiology and Outcomes
What is the association between board certification in interventional cardiology and procedure outcome?
The investigators identified physicians who performed ≥10 percutaneous coronary interventions (PCIs) in 2010 in the CathPCI Registry and determined board certification status using American Board of Internal Medicine data. In-hospital outcomes of patients treated by certified and noncertified physicians were compared using hierarchical multivariable models adjusted for differences in patient characteristics and PCI volume. Primary endpoints were all-cause in-hospital mortality and bleeding complications. Secondary endpoints included emergency coronary artery bypass grafting (CABG), vascular complications, and a composite of any adverse outcome.
The study group was comprised of 5,175 physicians, of whom 3,666 (70.8%) were board certified. There was no difference in case mix and unadjusted outcome between the two groups. The adjusted risks of in-hospital mortality (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.02-1.19) and emergency CABG (OR, 1.32; 95% CI, 1.12-1.56) were higher in the noncertified group, but there was no difference in the risks of bleeding, vascular complications, and the composite endpoint. Procedures performed by board-certified physicians were more likely to be rated Appropriate or Inappropriate while the nonboard-certified physicians had a higher proportion of procedures that could not be classified on appropriateness.
The authors concluded that board certification status of the operator is a poor predictor of outcome.
The business of physician certification has been under scrutiny lately, and this study adds some science to the debate. The current process has been criticized for being expensive and onerous, with little value to the patients. This study was not able to find a major difference in outcome based on the operators’ board certification status, and supports the need to modify the certification process.
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