Areas with high rates of cardiac procedures for patients hospitalized with coronary artery disease (CAD) seem to have a pool of patients with more need for the procedures and are not inappropriately overusing them. In fact, more extensive disease instead of physician practice style may be at the root of area practice variations in use of cardiac catheterization and revascularization for CAD patients, concludes Joseph D. Restuccia, Dr.P.H., of Boston University.
In a study supported by the Agency for Healthcare Research and Quality (HS06048), Dr. Restuccia and his colleagues created 70 small geographic areas based on hospital use patterns in Massachusetts in 1990. Using data from the early 1990s, they examined the appropriate use of cardiac catheterization among patients hospitalized primarily for CAD and of revascularization (bypass surgery or coronary angiography) among hospitalized CAD patients who underwent cardiac catheterization.
The researchers ranked areas from highest to lowest based on hospitalization rates for each procedure; 1,704 cases from 43 hospitals were sampled, about half each from high and low use. They examined medical records to determine whether each procedure was appropriate or, in the case of patients who did not have a procedure, would have been appropriate based on clinical criteria. The use rate for cardiac catheterization per 1,000 CAD patients in the highest rate group was 62 percent greater than in the lowest rate group. The use rate for revascularization per 1,000 CAD patients who had a cardiac catheterization in the highest rate group was 34 percent greater than in the lowest rate group.
Appropriateness rates were similar in the high and low use areas for either cardiac catheterization (82 vs. 84 percent) or revascularization (93 vs. 90 percent). However, among candidates for cardiac catheterization or revascularization who did not have the procedure, appropriateness for performing the procedure was greater in high-rate areas (41 vs. 32 percent for catheterization and 71 vs. 57 percent for revascularization).
See "Does more 'appropriateness' explain higher rates of cardiac procedures among patients hospitalized with coronary heart disease?" by Dr. Restuccia, Michael Shwartz, Ph.D., Bernard E. Kreger, M.D., M.P.H., and others, in the June 2002 Medical Care 40(6), pp. 500-509.