Flawed clinical judgement and breakdowns in communication between patients, their families, and doctors, as well as among providers themselves, are largely to blame for malpractice suits against cardiologists, according to a national malpractice insurer.

The report from The Doctors Company analyzed 321 cardiology-related malpractice claims closed between 2010 and 2025. Of those, 36% arose from medical treatment. Another 36% stemmed from diagnosis-related factors, including delayed diagnosis or failure to diagnose. Although 69% of the filed claims ended without any payout to the plaintiffs, the remainder resulted in an average payout of $394,000.

The report found that even claims that do not end up with a payout-imposed cost on the defendant doctors and insurance company at an average of $79,000.

Behavioral Factors Trending

“While the findings are consistent with previous years for the contributing factors, a notable trend exists in the behavioral factors associated with patient adherence to treatment regimens, medications, follow-up appointments, and diagnostic tests,” Julie Ritzman, senior vice president for patient safety and risk management at The Doctors Company, told Medscape Medical News.

She noted these factors have shown the highest mean paid indemnity.

“This underscores the critical importance of diligently following up with patients to ensure they attend their follow-up appointments, complete the prescribed tests, and adhere to their medication schedules,” Ritzman added. “Implementing a robust tracking system and meticulously documenting the steps taken to ensure patient compliance is essential for all medical specialties, including cardiology.”

The average payout for malpractice claims in cardiology falls “near the middle” compared with other specialties, Ritzman said. She cited an analysis by Milliman that showed the closed claim cost for cardiology through 2022 was nearly $400,000 vs more than $1.1 million for obstetrics and about $300,000 for general surgery.

The likelihood of a cardiologist getting sued for malpractice today is about a third of what it was a decade ago, said Fred Kusumoto, MD, director of heart rhythm services at Mayo Clinic in Jacksonville, Florida. Kusumoto is the lead author of a recent analysis of previous data from The Doctors Company from 2010 to 2023.

“The likelihood of facing a malpractice claim appears to be lower — now 3% when previously it was reported to be 9% a decade ago,” he said. “However, the claim will more likely be settled (29% of claims) compared to 14% a decade ago.”

The findings in the earlier data aligned with the latest report.

Patient nonadherence to their doctors’ recommendation was the largest prevailing factor for malpractice suits targeting cardiologists, Kusumoto said, particularly related to recommended treatments. This nonadherence was most commonly due to not taking medications but also included failure to get recommended blood tests for follow-up, he noted.

However, nonclinical factors were more common than clinical factors and patient factors as a reason for malpractice claims, Kusumoto said. Among the nonclinical factors were doctors’ lack of availability during a shift or during off hours, documentation, and communication between providers and between the doctor and patient.

“Now that cardiology care is often delivered by multiple providers often employed in large care groups, these care groups should ensure that effective communication with the patient and among providers is present, develop processes that verify accurate documentation (perhaps aided by artificial intelligence), provide mechanisms for follow-up, and address off-hours care,” he said.

‘Don’t Forget Soft Skills’

Cardiologists should be mindful in order to minimize their liability, said Cathleen Biga, MSN, immediate past president of the American College of Cardiology (ACC) and a member of the ACC Medical Professional Liability Insurance Work Group. “Don’t forget the soft skills,” she said. “Don’t forget that the communication is really, really important. Understand if your patient is noncompliant, document it.”

She noted that relying too much on electronic medical records (EMRs) can also give providers a false sense that they’re covering their liability exposure. “If your patient is noncompliant document it,” Biga said. “What’s such a problem in our healthcare system today is, time is of such an essence and the EMR with check boxes doesn’t help us document some of the information that’s critically important.”

Biga added, “EMR has not necessarily been our great friend as it relates to meaningful documentation.”

Coordination among providers is also key to mitigating liability, Biga said. Handing off patients from one provider to another can be particularly problematic. “As we get more and more subspecialized, especially in the United States, communication with all the different EMRs, all the different methods of documentation that we have, it can be very difficult to ensure we have solid communication,” she said.

Daniel Cassavar, MD, medical director of TDC Group, parent company of The Doctors Company and a practicing cardiologist, said the findings emphasize four key points for cardiologists to minimize their liability.

“Maintain a broad differential diagnosis during initial evaluation; clearly discuss management strategies, including treatment and procedural options; transparently articulate the clinical reasoning behind therapeutic decisions and recommendations; and take patient complaints seriously, particularly when symptoms escalate, as failure to do so may undermine patient trust,” Cassavar said.

Kusumoto and Biga reported having no relevant financial relationships. Ritzman and Cassavar reported being employees of TDC Group.

Richard Mark Kirkner is a medical journalist based in Philadelphia.