title: Variation in use of left ventriculography in the Veterans Affairs Health Care System.
abstract: BACKGROUND
  Contrast left ventriculography is a method of measuring left ventricular function usually performed at the discretion of the invasive cardiologist during cardiac catheterization. We sought to determine variation in the use of left ventriculography in the Veterans Affairs (VA) Health Care System.
  
  
  RESULTS
  We identified adult patients who underwent cardiac catheterization including coronary angiography between 2000 and 2009 in the VA Health Care System. We determined patient and hospital predictors of the use of left ventriculography as well as the variation in use across VA facilities. Results were validated using data from the VA's Clinical Assessment, Reporting, and Tracking (CART) program. Of 457 170 cardiac catheterization procedures among 336 853 patients, left ventriculography was performed on 263 695 (58%) patients. Use of left ventriculography decreased over time (64% in 2000 to 50% in 2009) and varied markedly across facilities (<1->95% of cardiac catheterizations). Patient factors explained little of the large variation in use between facilities. When the cohort was restricted to those with an echocardiogram in the prior 30 days and no intervening event, left ventriculography was still performed in 50% of cases.
  
  
  CONCLUSIONS
  There is large variation in the use of left ventriculography across VA facilities that is not explained by patient characteristics.
authors.affiliation: VA Palo Alto Health Care System, Palo Alto, CA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Shoutzu
authors.initials: S
authors.lastname: Lin
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Knowles
authors.forename: Marco
authors.initials: M
authors.lastname: Perez
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.forename: Michael P
authors.initials: MP
authors.lastname: Ho
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: Anju
authors.initials: A
authors.lastname: Sahay
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Thomas T
authors.initials: TT
authors.lastname: Tsai
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Witteles
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D005260:Female; D015637:Gated Blood-Pool Imaging / Q000706:statistics & numerical data*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D011859:Radiography; D017062:Small-Area Analysis; D014463:Ultrasonography; D014481:United States; D014493:United States Department of Veterans Affairs; D016277:Ventricular Function, Left
keywords: cardiac catheterization; cardiac imaging techniques; small-area analysis