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JAMA. Author manuscript; available in PMC 2017 June 05. Published in final edited form as: JAMA. 2015 November 17; 314(19): 2045–2053. doi:10.1001/jama.2015.13764.
Appropriate Use Criteria for Coronary Revascularization and Trends in Utilization, Patient Selection and Appropriateness of Percutaneous Coronary Intervention: Trends in Appropriateness of PCI
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Nihar R. Desai, MD, MPH, Steven M. Bradley, MD, MPH, Craig S. Parzynski, MS, Brahmajee K. Nallamothu, MD, MPH, Paul S. Chan, MD, MSc, John A. Spertus, MD, MPH, Manesh R. Patel, MD, Jeremy Ader, AB, Aaron Soufer, MD, Harlan M. Krumholz, MD, SM, and Jeptha P. Curtis, MD Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine (NRD, HMK, JPC), Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (NRD, CSP, HMK, JPC), Division of Cardiology, Department of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado (SMB); Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan (BKN); Department of Cardiovascular Research, Saint Luke’s Mid America Heart Institute, Missouri; Department of Medicine, University of Missouri-Kansas City, Missouri (PSC, JAS); Division of Cardiovascular Medicine, Duke Heart Center, Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina (MRP); Yale School of Medicine, New Haven, CT (JA); Department of Medicine, Yale School of Medicine, New Haven, CT (AS)
Abstract
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Address for correspondence: Nihar R. Desai, MD, MPH, Center for Outcomes Research and Evaluation, 1 Church Street, Suite 200, New Haven, CT 06510; 203-764-7424; (F) 203-764-5653; [email protected]. Role of the Sponsors The NCDR CathPCI Registry is an initiative of the ACC Foundation and the Society for Cardiovascular Angiography and Interventions. The manuscript was reviewed by the NCDR for compliance with registry description and representation but the sponsor did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; or decision to submit the manuscript for publication. Disclaimer The views expressed in this article represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies, identified at http://www.ncdr.com Conflicts of Interest Drs. Desai and Krumholz are recipients of a research agreement from Johnson & Johnson, through Yale University, to develop methods of clinical trial data sharing. Drs. Desai, Krumholz and Curtis receive funding from the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are used for public reporting. Dr. Krumholz receives research support from Medtronic, through Yale University, to develop methods of clinical trial data sharing and of a grant from the Food and Drug Administration to develop methods for post-market surveillance of medical devices. Dr. Krumholz chairs a cardiac scientific advisory board for UnitedHealth. Dr. Spertus discloses funding from the American College of Cardiology to analyze the NCDR registries, membership on the United Healthcare cardiac scientific advisory board and an equity interest in Health Outcomes Sciences. Dr. Patel has research grants through Duke University with Johnson and Johnson, AstraZeneca, Maquet, National Heart Lung and Blood Institute, AHRQ, and is on the Advisory Board for Bayer Healthcare, Jansen, and Genzyme. Dr. Curtis discloses equity interest in Medtronic. No other disclosures were reported.
Desai et al.
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Importance—Appropriate Use Criteria for coronary revascularization were developed to critically evaluate and improve patient selection for percutaneous coronary intervention (PCI). National trends in the appropriateness of PCI have not been examined. Objective—To examine trends in PCI utilization, patient selection, and procedural appropriateness following the introduction of Appropriate Use Criteria. Design, Setting, Participants—Multi-center, longitudinal, cross-sectional analysis of patients undergoing PCI between July 1, 2009 and December 31, 2014 at hospitals continuously participating in NCDR-CathPCI Registry over the study period. Main Outcome Measures—Proportion of non-acute PCIs classified as inappropriate at the patient- and hospital-level using the 2012 Appropriate Use Criteria for Coronary Revascularization.
Author Manuscript Author Manuscript
Results—A total of 2.7 million PCI procedures from 766 hospitals were included. Annual PCI volume for acute indications was consistent over the study period (2010: 377,540; 2014: 374,543), but the volume for non-acute PCIs decreased from 89,704 in 2010 to 59,375 in 2014. Among patients undergoing non-acute PCI, there were significant increases in angina severity (CCS III/IV angina, 15.8% and 38.4% in 2010 and 2014 respectively), use of anti-anginal medications prior to PCI (at least 2 anti-anginal medication, 22.3% and 35.1% in 2010 and 2014 respectively), and high-risk findings on non-invasive testing (22.2% and 33.2% in 2010 and 2014 respectively) (p
JAMA. Author manuscript; available in PMC 2017 June 05. Published in final edited form as: JAMA. 2015 November 17; 314(19): 2045–2053. doi:10.1001/jama.2015.13764.
Appropriate Use Criteria for Coronary Revascularization and Trends in Utilization, Patient Selection and Appropriateness of Percutaneous Coronary Intervention: Trends in Appropriateness of PCI
Author Manuscript Author Manuscript
Nihar R. Desai, MD, MPH, Steven M. Bradley, MD, MPH, Craig S. Parzynski, MS, Brahmajee K. Nallamothu, MD, MPH, Paul S. Chan, MD, MSc, John A. Spertus, MD, MPH, Manesh R. Patel, MD, Jeremy Ader, AB, Aaron Soufer, MD, Harlan M. Krumholz, MD, SM, and Jeptha P. Curtis, MD Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine (NRD, HMK, JPC), Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (NRD, CSP, HMK, JPC), Division of Cardiology, Department of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado; Department of Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, Colorado (SMB); Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan (BKN); Department of Cardiovascular Research, Saint Luke’s Mid America Heart Institute, Missouri; Department of Medicine, University of Missouri-Kansas City, Missouri (PSC, JAS); Division of Cardiovascular Medicine, Duke Heart Center, Duke Clinical Research Institute, Duke Medicine, Durham, North Carolina (MRP); Yale School of Medicine, New Haven, CT (JA); Department of Medicine, Yale School of Medicine, New Haven, CT (AS)
Abstract
Author Manuscript
Address for correspondence: Nihar R. Desai, MD, MPH, Center for Outcomes Research and Evaluation, 1 Church Street, Suite 200, New Haven, CT 06510; 203-764-7424; (F) 203-764-5653; [email protected]. Role of the Sponsors The NCDR CathPCI Registry is an initiative of the ACC Foundation and the Society for Cardiovascular Angiography and Interventions. The manuscript was reviewed by the NCDR for compliance with registry description and representation but the sponsor did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; or decision to submit the manuscript for publication. Disclaimer The views expressed in this article represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies, identified at http://www.ncdr.com Conflicts of Interest Drs. Desai and Krumholz are recipients of a research agreement from Johnson & Johnson, through Yale University, to develop methods of clinical trial data sharing. Drs. Desai, Krumholz and Curtis receive funding from the Centers for Medicare & Medicaid Services to develop and maintain performance measures that are used for public reporting. Dr. Krumholz receives research support from Medtronic, through Yale University, to develop methods of clinical trial data sharing and of a grant from the Food and Drug Administration to develop methods for post-market surveillance of medical devices. Dr. Krumholz chairs a cardiac scientific advisory board for UnitedHealth. Dr. Spertus discloses funding from the American College of Cardiology to analyze the NCDR registries, membership on the United Healthcare cardiac scientific advisory board and an equity interest in Health Outcomes Sciences. Dr. Patel has research grants through Duke University with Johnson and Johnson, AstraZeneca, Maquet, National Heart Lung and Blood Institute, AHRQ, and is on the Advisory Board for Bayer Healthcare, Jansen, and Genzyme. Dr. Curtis discloses equity interest in Medtronic. No other disclosures were reported.
Desai et al.
Page 2
Author Manuscript
Importance—Appropriate Use Criteria for coronary revascularization were developed to critically evaluate and improve patient selection for percutaneous coronary intervention (PCI). National trends in the appropriateness of PCI have not been examined. Objective—To examine trends in PCI utilization, patient selection, and procedural appropriateness following the introduction of Appropriate Use Criteria. Design, Setting, Participants—Multi-center, longitudinal, cross-sectional analysis of patients undergoing PCI between July 1, 2009 and December 31, 2014 at hospitals continuously participating in NCDR-CathPCI Registry over the study period. Main Outcome Measures—Proportion of non-acute PCIs classified as inappropriate at the patient- and hospital-level using the 2012 Appropriate Use Criteria for Coronary Revascularization.
Author Manuscript Author Manuscript
Results—A total of 2.7 million PCI procedures from 766 hospitals were included. Annual PCI volume for acute indications was consistent over the study period (2010: 377,540; 2014: 374,543), but the volume for non-acute PCIs decreased from 89,704 in 2010 to 59,375 in 2014. Among patients undergoing non-acute PCI, there were significant increases in angina severity (CCS III/IV angina, 15.8% and 38.4% in 2010 and 2014 respectively), use of anti-anginal medications prior to PCI (at least 2 anti-anginal medication, 22.3% and 35.1% in 2010 and 2014 respectively), and high-risk findings on non-invasive testing (22.2% and 33.2% in 2010 and 2014 respectively) (p
