CHICAGO — The acquisition of cardiovascular practices by private equity firms has ballooned in recent years. Of the 342 cardiology clinics that have been acquired in the past decade, more than 94% occurred from 2021 to 2023.
Cardiology is rather newto theprivate equity space compared with specialties such as orthopedics, ophthalmology, and dermatology, speakers reported during a forum at the American College of Cardiology (ACC) Scientific Session 2025. And because the experiences are new, there is considerable disagreement about how this trend will affect the field.
“Private equity is neither inherently good nor bad,” and it is not a uniform concept, said Jerry Blackwell, MD, MBA, president and chief medical officer of MedAxiom, an ACC organizational performance solutions company in Neptune Beach, Florida.
There is “tremendous heterogeneity” in private equity ownership contracts, and gaps in the field of cardiology make it ripe for change. “If there wasn’t a problem, private equity wouldn’t be part of the game,” Blackwell pointed out.
Cardiovascular practices are small and fragmented, but scalability is possible, which is driving private equity interest in cardiology. Plus, waste is rampant. And the market value of cardiovascular medicine is quite large, and the business models are complex. “If you put that in a blender,” that’s what private equity aims to solve in all of its industries, Blackwell said.
Financial Industry Involvement in Health
Those critical of private equity say that patients and healthcare professionalism take a back seat in acquisition discussions. But private equity might not be much different from other ownership models in that respect, Blackwell said. “At scale, healthcare providers are once again abdicating ownership to the financial industry.”
“Private equity in the hospital space is nothing like private equity in the practice space,” he cautioned. “Most of the horror stories you’re going to hear are in the hospital space. There are some horror stories in the practice space, but they’ve got nothing to do with cardiology.”
But what do practices look like once private equity firms exit? When private equity companies complete their short-term restructuring, the goal is typically to sell the practice and turn a profit for investors. So far, there has been little transparency in the way private equity firms operate in cardiology, Blackwell explained.
Arguments in favor of private equity generally center on the infusion of capital and resources to help struggling hospitals and practices thrive and the operational expertise in efficiency and quality they bring, said Rishi K. Wadhera, MD, associate director of the Smith Center for Outcomes Research and a cardiologist at Beth Israel Deaconess Medical Center in Boston, who coauthored recent report on private equity acquisitions of outpatient cardiology practices.
The negative argument is that because of the way private equity incentives are structured, “there is a strong incentive to generate financial returns over very short time horizons. There’s concern that that could adversely affect patient care,” he explained.
Hospital Horror Stories
Among older adults, there was a 25% increase in hospital-acquired adverse events in private equity hospitals compared with that in control-group hospitals, according to a 2023 study.
This increase “was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line–associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines,” the authors wrote.
And there is a drop in the patient-care experience after acquisition, according to another study, also co-authored by Wadhera. “What we found was that private equity acquisition leads to a 5 percentage point decrease in global measures of the patient-care experience,” he reported. “That is considered large. For context, that exceeds changes in the patient-care experience seen during the height of the COVID-19 pandemic.”
Evidence suggests that the private equity acquisition of hospitals increases resource use and worsens quality of care. “That’s the evidence base I feel most confident about,” Wadhera said. But so far, little is known about what happens in cardiology practices after private equity acquisition.
“It will be very interesting to see what sort of regulatory interventions, if any, are put into place, given, at least, the perspective of some of the investigations that have been launched,” he said.
Blackwell reported no relevant financial relationships. Wadhera received fees from Abbott Laboratories, CVS Health, and Chamber Cardio.