Researchers from Philadelphia-based University of Pennsylvania’s Leonard Davis Institute of Health Economics recently found that coronary artery bypass grafts are the most lucrative cardiology procedures for hospitals nationwide.
The surgeries, which aim to improve blood flow to the heart, were performed about 150,000 times between 2016 to 2019 and resulted in $1.5 billion in hospital profits.
At the same time, many cardiology leaders are calling for an increased emphasis on prevention programs, despite generating less revenue.
Becker’s asked four cardiology leaders how their organizations are balancing resources between lucrative procedures and low-cost prevention strategies.
Editor’s note: Responses have been lightly edited for clarity and length.
Jack Boyd, MD. Cardiac Surgeon at Stanford Health Care and Clinical Associate Professor of Cardiothoracic Surgery at Stanford (Calif.) University: A recent American Heart Journal article identified the large contribution margin coronary artery bypass grafting surgery makes to hospitals. This has appropriately focused attention on the procedure and cardiovascular care in general. CABG surgery can improve quantity and quality of life in the right patient more so than any other treatment. It is an option frequently chosen as the last resort. Hopefully, this does not distract from the overall efforts Stanford Health Care and other leading health systems continue to place across the entire spectrum of cardiovascular health. We wholeheartedly subscribe to: “an ounce of prevention is worth a pound of cure.”
Multiple projects are currently underway at Stanford focused on cardiovascular prevention. Researchers are identifying and notifying patients who have incidental coronary calcium detected on non-cardiac imaging utilizing an AI algorithm. This will be incorporated into a clinical program designed to increase access to cardiometabolic prevention. Patients who might have otherwise been missed for the initiation of coronary artery disease medical therapy will receive care. Furthermore, quality initiatives are underway to facilitate optimal medication titration for heart failure and lipid management in primary care clinics. These efforts will soon be expanded into GLP-1 therapies.
Arun Kumar, MD. Division Director of Cardiovascular Medicine at University of Missouri Health Care (Columbia): Our cardiology group at MU Health Care takes a strong focus on prevention. We have several initiatives to address heart disease early. This includes heart health screenings, a Women’s Heart Clinic, and a “Love Your Heart” screening program, which identifies patients at risk for future heart disease by conducting blood tests and CT imaging. At-risk patients visit our cardiologists to discuss risk factor control.
Our team also focuses on less invasive options that don’t involve open-heart surgery. This includes coronary stent and valve procedures that can be performed less invasively than the CABG or open-heart valve replacement.
The key is finding the best treatment for our patients that is tailored to their condition and other medical needs. Sometimes open-heart surgery can be the best option, but we are proud to offer multiple options and weigh through the pros/cons in a conversation that is patient-centered and evidence-based.
MU Health Care also believes strongly in engaging the community to promote heart health and prevention of future cardiac events. For example, we sponsor heart walks, community talks and screenings.
Gregory Mishkel, MD. Vice President of Cardiology Operations and Chief of the Division of Cardiology at NorthShore University HealthSystem/Endeavor Health (Evanston, Ill.): All hospitals, including our own, must be acutely aware of the financial health of cardiovascular services, recognizing that the margin from procedures like CABG helps fund strategic investments and less profitable areas of care. That said, there is never pressure to prioritize procedures over what is best for the patient. When interventions are necessary, we intensify efforts around secondary prevention, addressing modifiable risk factors to prevent disease progression.
On the primary prevention front, we’re investing in earlier identification of risk. Coronary artery calcium scoring is being used more routinely and we’ve launched an AI protocol to automatically quantify coronary calcium from non-cardiac CT scans. We’ve also developed a polygenic risk score to assess genomic risk for multiple cardiovascular conditions, including coronary artery disease.
Additionally, we are creating a systemwide collaborative focused on identifying and managing cardiometabolic disease and obesity. A key focus is integrating novel therapies such as SGLT2 inhibitors and GLP-1 receptor agonists, which have shown significant cardiovascular risk reduction. These efforts reflect a shift toward comprehensive, upstream strategies that reduce the need for invasive procedures and align with value-based care.
Robert Ostfeld, MD. Director of Preventive Cardiology at Montefiore Health System (New York City): Montefiore Heath System believes strongly in the power of prevention. Its Cardiac Wellness Program helps support and encourage patients to adopt more plant-based nutrition and a more healthful lifestyle overall. In fact, numerous patients who had been advised to pursue CABG or coronary stents at outside institutions have sought out our Cardiac Wellness Program, as they did not wish to pursue such procedures. In many cases, with lifestyle change and medications, they have improved clinically and have been able to avoid invasive procedures, in accordance with their wishes.
In 2017, Montefiore created ethnically relevant plant-based and plant-forward meals which can be ordered for inpatients and are also served in our outpatient cafeterias. Accordingly, Montefiore has developed an educational film for associates describing the beneficial impact of plant-forward nutrition on health, describing how these meals can be ordered for inpatients and providing suggestions as to how the entire medical team can help encourage the patient to adopt a more healthful lifestyle long term. This film will feature on Montefiore’s internal learning channel in the coming months.
Furthermore, Montefiore’s Cardiology Fellows all include a brief nutrition assessment in their consult notes, reinforcing the importance of a healthful lifestyle to patients, to those reading the consult notes, and to our fellows, who will later graduate and provide care worldwide.
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