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.