PRESS RELEASE: More heart specialists, more low-value stents: New study links interventional cardiologist supply to overuse of non-emergency heart procedures
National analysis of nearly 1,600 hospitals finds that regions with the most PCI-performing physicians deliver a disproportionately higher share of stents and angioplasties to patients who are unlikely to benefit.
In parts of the country with the greatest concentration of physicians who perform coronary stenting and angioplasty, patients are more likely to receive those procedures for stable heart disease, a use that major clinical trials have shown offers little or no benefit over medication alone, according to a new study from researchers at the Lown Institute published in PLOS ONE.
The finding adds a new dimension to a decades-old observation in health services research: that the supply of medical resources in a region tends to drive how much they are used. The Lown study is among the first to show that a greater supply of specialists is tied not just to more care overall, but to a disproportionate increase in low-value care specifically.
Key findings include:
- After adjusting for differences in patient health, community characteristics, and hospital factors, hospitals in the highest provider-density regions delivered a 5.77 percentage-point higher share of low-value PCIs than those in the lowest.
- Both overall and low-value procedure rates climbed with supply. Moving from the lowest- to highest-supply regions, total PCIs rose from 15.1 to 31.3 per 1,000 Medicare beneficiaries, while low-value PCIs roughly tripled, from 2.6 to 7.9 per 1,000.
- Each additional PCI provider in a region was associated with roughly 225 additional procedures.
“When we build more capacity to perform a procedure, that capacity tends to get used, and not only for the patients who need it most,” said Vikas Saini, MD, president of the Lown Institute and a co-author of the study. “What’s striking here is that adding specialists didn’t just raise the overall volume of stents. It raised the share of stents going to patients who were least likely to benefit. That’s a signal that supply itself is helping to drive overuse.”
The authors argue that the findings complicate a common policy prescription: that expanding the supply of providers will lower costs by increasing competition.
“Targeting resources like interventional cardiologists to the communities that actually need them, rather than clustering them where the revenue is, could reduce waste, contain costs, and protect patients from procedures that carry real risks without real benefits,” said lead author Adam Gaffney, MD, MPH. “By planning the health workforce more deliberately, we can more effectively direct resources to the patients and communities with the greatest need.”
Percutaneous coronary interventions (PCIs), procedures that open blocked arteries with a stent or balloon, can be lifesaving for patients having a heart attack or an unstable cardiac event. But for patients with stable coronary artery disease, randomized trials including COURAGE, ISCHEMIA, and ORBITA have found that PCI does not reduce the risk of death compared with medication, and in at least one placebo-controlled trial offered no greater symptom relief than a sham procedure. More than 600,000 PCIs are performed in the United States each year.
The new findings build on a 2023 Lown Institute analysis of a similar data set that found U.S. hospitals performed more than 229,000 unnecessary coronary stents on Medicare patients over three years — roughly one every seven minutes — at a cost of $2.44 billion, or about $800 million a year.
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About the Lown Institute
The Lown Institute is an independent think tank advocating bold ideas for a just and caring system for health. We envision a healthcare system focused on what’s best for people, like hospitals caring for those most in need, patients living without fear of financial distress, and health professionals finding joy in their roles. The Lown Hospitals Index is a signature project of the Institute and the first ranking to assess the social responsibility of U.S. hospitals, including measures like community investment, medical overuse, and CEO pay.
Contact
Aaron Toleos, Lown Institute, (978) 821-4620, atoleos@lowninstitute.org