Trained and Supervised Physician Assistants Can Safely Perform Diagnostic Dardiac Catheterization and Coronary Angiography
Richard. A Krasuski, John J. Warner, Andrew Wang,
J. Kevin Harrison, John F Bolles, Erica L Moloney,
Carole Ross, Thomas M. Bashore, and Michael H. Sketch, Jr.
Keywords:Heart catheterization, Outcomes assessment, Health services
Background:The rising costs of medical care and the shortage of qualified physicians has led to the routine use of physician extenders in the provision of medical services. Some academic and proprietary medical centers use physician extenders to assist in diagnostic cardiac catheterization. Despite this fact. the safety of this practice has not been formally examined.
Methods:Trained physician's assistants (PA) were granted privileges to perform diagnostic coronary angiography under close supervision of an attending physician at our institution in July 1998. The demongraphic information and results of cardiac catheterization were prospectively collected in a database. We compared the results of 929 diagnostic cardiac catheterizations performed by PAs betwen July 1998 and April 2000 with 4521 catheterizations performed by cardiology fellows with similar supervision during the same period.
Results:The demographics of patients undergoing cardiac catheterization by PAs did not differ from patients undergoing diagnostic cardiac catheterizationi by fellows in terms of gender, race, angina class, prevalence of diabetes, obesity, number of diseased coronary arteries or LV ejection fraction. Class III and IV congestive heart failure was more common in fellow cases (19.5% of fellow cases and 13.2% of PA cases, p = 0.001). PA cases tended to be slightly faster (70.2 +/- 32.6 minutes vs 72.6 +/- 35.2, p = 0.05) and used less fluoroscopic time (10.2 +/- 6.5 minutes vs 12.2 +/- 9.9, p = 0.0001). No difference in the volume of contrast media used was seen. The incidence of major complications including myocardial infarction, stroke, arrhythmia requiring defibrillation or pacemaker placement, pulmonary edema requiring intubation and vascular complications requiring surgical intervention were similar between the two groups (0.22% in PA cases and 0.24% in fellow cases).
Conclusons:Under the careful supervision of experienced cardiologists, trained physican assistants can perform diagnostic cardiac catheterization, including coronary angiography, with procedural times and complication rates similar to those of cardiology fellows in training.