Discussion
To our knowledge, this is the first national survey-based study designed to assess the OHHs in interventional cardiologists in China. With an appropriate control (i.e., non-interventional cardiologists) and propensity score methods, this study revealed that interventional cardiologists in China experience significantly higher incidence of body pain, mainly of the back. Long working hours may play an important role in the development of body pain. Even with relatively short occupational experience of ICPs (average 8.8 years), other OHHs, such as bone and joint diseases, cataract, and anxiety, were found significantly more common in interventional cardiologists in China.
The last two decades have witnessed a rapid growth in number of interventional cardiologists in tertiary hospitals in China. They are relatively younger and have relatively shorter ICP working years than their colleagues in the developed countries. The reported median age of interventional cardiologists in the United States was 48 years17, approximately 10 years older than the median age of Chinese counterparts surveyed in this study. However, the large patient population and the relative shortage of well-trained colleagues have led to an overwhelming workload. The surveyed interventional cardiologists conducted > 340 ICPs per year on average, which is a much higher personal volume than that reported previously (200 per year in Europe18 and 268 per year19 in the United States). The high annual personal volume may explain the comparable prevalence of body pain in relative younger interventional cardiologists in China, that in a US multispecialty survey of physicians including interventional cardiologists (mean age: 46.9 years), 53% of them reported having received treatment for their neck or back pain20.
This study also explored risk factor for back pain in interventional cardiologists. We found female counterparts were associated with higher risk of back pain, which is not surprising, as males usually have better pain tolerance than females21. Interventional cardiologists conducting > 1 type of ICPs are more likely to develop back pain. In hospitals with high patient volume, some interventional cardiologists were trained to conduct different types of ICPs, which inevitably results in longer work hours. Significantly positive correlation was found between the personal annual ICP volume and development of back pain, indicating the impact of the lead PPE on back pain.
Persistent back pain diminishes quality of life, reduces productivity, and leads to early career termination in healthcare workers6, 20, 22. Therefore, mitigation of back pain is critical to meet the occupational health needs of interventional cardiologists in China.
This study also addressed the level of satisfaction with PPE and PHP needs. Interventional cardiologists are not fully satisfied with the current lead PPE due to its heavy weight and concerns about its protective efficacy against radiation exposure. These dissatisfactions, concerns and the consequential OHHs along with other factors, such as income and family, have caused over one-third of the surveyed interventional cardiologists to consider early termination of their ICP career, which is in contrary to the increasing demand of ICPs in China. Thus, corresponding solutions address these health needs and PHP needs begin to become urgent issues. For example, the Society of Interventional Radiology advised that interventional radiologists should avoid prolonged standing while on lead PPE operating in an awkward or poor posture (necessitated by leaning or bending to accomplish procedures) to prevent back pain among the profession23. Considering the high personal annual volume of procedures, training more interventional cardiologists to reduce personal workload can be an effective approach to alleviate their back pain burden. Lastly, most interventional cardiologists expect novel technologies to conduct ICPs without radiation exposure and wearing PPE. Fortunately, zero-fluoroscopy ablation procedures have already been developed and conducted in real-world settings24, mostly using non-fluoroscopic 3-D electroanatomical navigation system combined with intracardiac echocardiography and contact force technologies, which can be a promising alternative method to reduce incidence of OHH, especially body pain during ICPs.