Patient and Hospital Characteristics Associated with Inappropriate Percutaneous Coronary Interventions.
J Am Coll Cardiol. 2013 Sep 6;
Authors: Chan PS, Rao SV, Bhatt DL, Rumsfeld JS, Gurm HS, Nallamothu BK, Cavender MA, Kennedy K, Spertus JA
Abstract
OBJECTIVE: To examine whether rates of inappropriate PCI differ by demographic characteristics and insurance status.
BACKGROUND: Prior studies have found that blacks, women and those with public or no health insurance are less likely to undergo percutaneous coronary intervention (PCI). Whether this reflects potential overuse in whites, men, and privately insured patients, in addition to underuse in disadvantaged populations, is unknown.
METHODS: Within the NCDR(®) CathPCI Registry(®), we identified 221,254 non-acute PCIs performed between July 2009 and March 2011. PCI appropriateness was determined using Appropriate Use Criteria (AUC) for coronary revascularization. Multivariable hierarchical regression models evaluated the association between patient demographics and insurance status with AUC-defined inappropriate PCI.
RESULTS: Of 211,254 non-acute PCIs, 25,749 (12.2%) were classified as inappropriate. After multivariable adjustment, men (adjusted OR, 1.08 [95% CI: 1.05-1.11]; P<0.001) and whites (adjusted OR, 1.09 [1.05-1.14]; P<0.001) were more likely to undergo an inappropriate PCI, compared with women and non-whites. Compared with privately insured patients, those with Medicare (adjusted OR, 0.85 [0.83-0.88]), other public insurance (adjusted OR, 0.78 [0.73-0.83]) and no insurance (adjusted OR, 0.56 [0.50-0.61]) were less likely to undergo an inappropriate PCI (P<0.001). Additionally, compared with urban hospitals, those admitted at rural hospitals were less likely to undergo inappropriate PCI, whereas those at suburban hospitals were more likely.
CONCLUSION: For non-acute indications, PCIs categorized as inappropriate were more commonly performed in men, patients of white race, and those with private insurance. Higher rates of PCI in these patient populations may be, in part, due to procedural overuse.
PMID: 24055743 [PubMed - as supplied by publisher]