According to a research letter published in the Annals of Internal Medicine, cardiac catheterization and electrophysiology laboratory directors have significant financial relationships with industry, which may violate conflict of interest guidelines defined by the National Academy of Medicine.

The investigators extracted nonresearch payment data for 2017 from the Open Payments Program (OPP) and identified laboratory directors for the top 100 US cardiovascular hospitals ranked by the 2017 US News & World Report. They compared payments made to the identified laboratory directors with those made to interventional cardiologists and electrophysiologists practicing in the same zip codes as well as in other areas of the country. Types of financial transactions were characterized according to 13 OPP categories: compensation for services, consulting fees, food and beverage, travel and lodging, speaking at continuing education events, honoraria, grants, education, ownership or investment interest, charitable contribution, entertainment, royalties, and gifts.

Directors of cardiac catheterization and electrophysiology laboratories, who were affiliated with the top 100 cardiovascular hospitals, received a total of $1,416,232 and $2,307,504, respectively. Out of 195 laboratory directors included, only 11 received no payments in 2017. Cardiac catheterization directors received significantly greater median payments than interventional cardiologists practicing in the same zip codes ($3203 vs $1064); similarly, electrophysiology directors received greater payments than electrophysiologists practicing in the same zip codes ($10,521 vs $2900). This was also true when comparing the laboratory directors with payments to interventional cardiologists ($883) and electrophysiology physicians ($2267) across the country.

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Limitations to the study included possible misclassifications in identifying laboratory directors due to a systemic approach and potential inaccuracies in OPP data.

The investigators suggest that a significant proportion of cardiac catheterization and electrophysiology laboratory directors have notable financial ties with the industry; directors receiving $10,000 or more risk violating conflict of interest guidelines. Future research should aim to understand whether industry payments to laboratory directors influence clinical-decision making.

Disclosure: Jeptha P. Curtis, MD, holds equity interest in Medtronic.


Annapureddy A, Sengodan P, Mahajan S, et al. Distribution of industry payments among medical directors of catheterization and electrophysiology laboratories from the top 100 US hospitals [published online June 17, 2019]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.8775