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Sidebar: The Psychology of Coronary Physiology

In a recent study published in JACC: Cardiovascular Interventions, researchers found that the most frequently cited reason for avoiding use of physiologic assessment was operator confidence in their ability to make a treatment decision based on angiography and clinical presentation only.

In an accompanying editorial, Nils Johnson, MD, associate professor of medicine at McGovern Medical School at UTHealth (Houston), and Bon-Kwon Koo, MD, PhD, from Seoul National University in South Korea, noted that this study highlights the disconnect between the perceived reasons why coronary physiology is not being performed and the actual reasons.

“People often tell you that they understand the data and how to do FFR or iFR, but they don’t do it because the wires may not be as good or they have problems with hyperemia or there are reimbursement issues. What’s been interesting, however, is that studies looking at each one of those aspects have shown that that’s not true,” Johnson told Cardiology Today’s Intervention.

More likely than not, it boils down to psychology, he noted.

“In summary, the ERIS study helps us critically evaluate responses to the question, ‘Why don’t interventional cardiologists use coronary physiology?’” Johnson and Koo wrote in their editorial. “Although operators can be reluctant to admit it, the fundamental reason has received different labels: attitude, belief, local practice, ‘experience’ and culture. Put simply, we as a profession do not yet emotionally accept coronary physiology to guide treatment. Call it ‘coronary psychology.’” – by Melissa Foster

In a recent study published in JACC: Cardiovascular Interventions, researchers found that the most frequently cited reason for avoiding use of physiologic assessment was operator confidence in their ability to make a treatment decision based on angiography and clinical presentation only.

In an accompanying editorial, Nils Johnson, MD, associate professor of medicine at McGovern Medical School at UTHealth (Houston), and Bon-Kwon Koo, MD, PhD, from Seoul National University in South Korea, noted that this study highlights the disconnect between the perceived reasons why coronary physiology is not being performed and the actual reasons.

“People often tell you that they understand the data and how to do FFR or iFR, but they don’t do it because the wires may not be as good or they have problems with hyperemia or there are reimbursement issues. What’s been interesting, however, is that studies looking at each one of those aspects have shown that that’s not true,” Johnson told Cardiology Today’s Intervention.

More likely than not, it boils down to psychology, he noted.

“In summary, the ERIS study helps us critically evaluate responses to the question, ‘Why don’t interventional cardiologists use coronary physiology?’” Johnson and Koo wrote in their editorial. “Although operators can be reluctant to admit it, the fundamental reason has received different labels: attitude, belief, local practice, ‘experience’ and culture. Put simply, we as a profession do not yet emotionally accept coronary physiology to guide treatment. Call it ‘coronary psychology.’” – by Melissa Foster