ABSTRACT
Coronary heart disease is currently the leading cause of death globally, and is expected to account for 14.2% of all deaths by 2030. The emergence of novel technologies from cardiothoracic surgery and interventional cardiology are welcome developments in the light of an overwhelming chronic disease burden. However, as these complementary yet often competing disciplines rely on expensive technologies, hastily prepared resource plans threaten to consume a substantial proportion of limited healthcare resources. By describing procedural and professional trends as well as current and emerging technologies, this review aims to provide useful knowledge to help managers make informed decisions for the planning of cardiovascular disease management. Since their inception, developments in both specialties have been very rapid. Owing to differences in patient characteristics, interventions and outcomes, results of studies comparing cardiothoracic surgery and interventional cardiology have been conflicting. Outcomes for both specialties continue to improve through the years. Despite the persistent demand for coronary artery bypass surgery (CABG) as a rescue procedure following percutaneous coronary intervention (PCI), there is a widening gap between the numbers of PCI and CABG. Procedural volumes seem to have affected career choices of physicians. Emerging technologies from both disciplines are eagerly awaited by the medical community. For long-term planning of both disciplines, conventional health technology assessment methods are of limited use due to their rapid developments. In the absence of established prediction tools, planners should tap alternative sources of evidence such as changes in disease epidemiology, procedural volumes, horizon scan reports as well as trends in disease outcomes
Until the end of the first half of the 20th century, the management of coronary heart disease (CHD) lay largely in the hands of general cardiologists. Subsequently, treatment of CHD was influenced by breakthroughs from two complementary yet often competing subspecialties. Coronary artery bypass graft surgery (CABG) was the first definitive intervention introduced in the 1960s by cardiothoracic surgeons. More than a decade later, a group of physicians who were eventually called interventional cardiologists performed the first human coronary angioplasty. To this day, both technologies continue to evolve, at times with one discipline announcing the impending arrival of a breakthrough before the other could finish celebrating its most recent success.
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