Cardiology Policy

Cardiology’s Industry Payments Problem

Healthcare watchdogs set their sights on cardiology’s industry payments last week, revealing some key examples of how vendor payments could influence the approval and adoption of major cardiovascular technologies.

A KFF Health News exposé revealed that 10 out of the 14 members of the FDA expert advisory panel that evaluated Abbott’s TriClip G4 System received industry payments from Abbott between 2016 and 2018. 

  • Those payments added up to roughly $650k, with at least three panelists each linked to over $100k in payments.
  • Most payments came in the form of research funding or smaller consulting fees, the payments weren’t necessarily associated with the TriClip, and all parties assured that they maintained objectivity and followed standards.
  • However, most people likely paid more attention to the fact that this panel voted 13-1 in favor of the TriClip G4, leading to its FDA approval within a few months.

Meanwhile, a JAMA paper revealed that cardiologists who received industry payments from Abiomed were far more likely to use the company’s Impella LVAD pump. Analysis of 6,398 cardiologists between 2016 and 2018 (1,871 who placed ≥1 LVAD), revealed that: 

  • Cardiologists who received payments from Abiomed were far more likely to have implanted at least one Impella LVAD than cardiologists who didn’t receive payments from the company (23.2% vs. 9.5%). 
  • Cardiologists who received payments from Abiomed in a given year were twice as likely to use an Impella device during that year and the following year (ARRs: 2.04 & 1.90).
  • Although some CardioTwitter commenters suggested that this is a sign of questionable commercial influence, many others noted that this payment/use correlation is due to the simple fact that LVAD experts are more likely to be paid to do LVAD research and consulting than non-experts.

The Takeaway

US physicians raked in $12.13 billion in industry payments between 2013 to 2022, so these reports don’t necessarily reveal unique problems with Abbott and Abiomed, or even within cardiology. 

They do, however, highlight the fact that the physicians who are most likely to participate in expert panels or adopt cutting-edge technologies are also the most likely to be involved in industry-funded activities like research or consulting. Whether these industry-funded activities cause (or just correlate with) downstream regulatory approvals and device use is far less clear.

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