In a recent study published in Revista Española de Cardiología, de la Torre Hernández et al.1 conclude that cardiovascular technology use varied considerably across Spain's autonomous communities and that the variability observed could not be explained by economic factors or number of hospital visits. The authors made several references to «equal opportunities» and even mentioned «country-wide deficiencies in equitable access to cardiovascular interventions of proven clinical effectiveness». Based on the study's findings, we believe it may be somewhat rash to draw an inverse correlation between variability in technology use and equitable access to health care interventions. The authors acknowledge certain limitations of their study,1 and these are neatly illustrated in an editorial on the subject.2 Age is one of many factors not assessed in the study that can influence the use of cardiovascular procedures. An autonomous community with an older population, for example, may perform more procedures. Using a simple analysis of data from 2019, we observed a direct regional correlation between mean population age and the number of cardiovascular procedures performed in Spain (figure 1). Variability in clinical practice is certainly an important issue and one that calls for in-depth analysis. Notwithstanding, clinical guidelines leave ample room for case-by-case decision-making. They do not provide recommendations on many clinical situations and should not be followed indiscriminately.

Figure 1.

Correlation between number of cardiovascular procedures studied by Torre Hernández et al.1 and mean population age by autonomous community in 2019. Data obtained from the Spanish Registry of Hemodynamics and Interventional Cardiology3 and the National Statistics Institute, respectively.

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