The Truth Is in the Details
The Case for Not Missing the Trees for the Forest
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Article, see p 24
Over the past 2 decades, the cardiovascular medicine community has witnessed an exponential increase in the number and complexity of procedures to diagnose and treat arrhythmias and their sequelae. Driven both by the aging of the population in the United States1 and by the rapid pace of technological advances in device manufacturing and catheter designs, cardiac electrophysiology has evolved from a fringe interest to an established subspecialty of cardiology with its own dedicated training programs and board certification examinations. Today, an estimated 100 fellows complete their electrophysiology training every year in the United States2 and go on to service a growing number of electrophysiology laboratories in academic, community, urban, and rural settings. The dramatic increase over the past 10 years in the number of medical facilities that provide invasive electrophysiology services mirrors a similar phenomenon witnessed a decade earlier with the mushrooming and spreading of cardiac catheterization laboratories from large tertiary care centers to all communities.
As the field of cardiac electrophysiology continues to expand and mature, it is imperative that we all remain mindful of the impact that this expansion may have on the quality of care we provide to our patients, both at the national level and within our own individual practice settings. To that end, examining the complication rates associated with our expanding armamentarium of invasive procedures and our ever-changing tools and practice settings is crucial because these complications have a direct and profound impact on patient outcomes and cost of care. This unflinching scrutiny, which should be part of an internal quality control policy within each electrophysiology laboratory, must be thorough and systematic. Unfortunately, a tendency to underestimate true rates of …