Vendor payments not responsible for rising popularity of LAAO procedures
A recent study showed no evidence of increased procedural volumes of left atrial appendage occlusion (LAAO) due to vendors paying operators.
Cardiovascular Business spoke with Alexander Kolomaya, MD, a cardiology resident at the University of Utah, who was involved with the study. He said it sheds light on rising national trends in LAAO procedures and explores the relationship between procedural volume and financial payments from device manufacturers to implanting physicians. He presented the finding at the American Heart Association (AHA) 2024 Scientific Sessions.
The researchers tracked data from 2017 to 2021, focusing on Medicare beneficiaries undergoing LAAO with Boston Scientific's Watchman device, a commonly used endovascular implant designed to reduce stroke risk in patients with atrial fibrillation.
“We’ve seen a consistent rise in the popularity of this procedure,” Kolomaya said. “It’s clear that both patients and providers are showing increasing interest in LAAO. What we wanted to better understand was whether industry payments to physicians had any correlation with this growth.”
To investigate this, Kolomaya and colleagues cross-referenced physician procedure volume from the Centers for Medicare and Medicaid Services (CMS) database with public Open Payments data from Boston Scientific during the study period. They examined non-research payments, such as consulting fees and honoraria, received by physicians performing the procedure.
“One of our goals was to determine whether physicians who received more in vendor payments were performing more procedures,” Kolomaya explained. “Surprisingly, we didn’t find a significant relationship between payment amount and procedural volume.”
While the data did not suggest undue influence from vendor compensation, the study uncovered striking regional variation in LAAO use across the United States. States such as Nebraska, Kansas, South Dakota, and North Dakota led the nation in per-capita implantations, while several smaller, northeastern states reported the lowest rates.
“These differences were unexpected,” said Kolomaya. “In some of the higher-volume states, fewer physicians may be performing the procedure, potentially funneling more cases to designated experts. Conversely, areas with low implantation rates may lack access or local expertise.”
Kolomaya noted that the analysis did not delve into sub-state regions or institutional practice patterns, leaving room for further investigation.
“Understanding why certain states lead in adoption while others lag could help inform policy and resource allocation, especially given the procedure’s growing popularity," he said.
The study also underscores the importance of procedural proficiency.
“There’s a learning curve to implanting LAAO devices,” Kolomaya added. “Centers or providers with higher volumes may be more confident or efficient, which might drive patient referrals and regional dominance.”
Despite its limitations, the study offers critical insight into a fast-growing field of interventional cardiology and provides reassurance regarding the integrity of physician decision-making in relation to industry ties—at least for now.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]