Issue: June 2020
Disclosures: Hess reports he received a grant from the U.S. Department of Veterans Affairs Health Services Research and Development. Please see the study for all other authors’ relevant financial disclosures.
April 21, 2020
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10% of PCIs at VA hospitals considered rarely appropriate

Issue: June 2020
Disclosures: Hess reports he received a grant from the U.S. Department of Veterans Affairs Health Services Research and Development. Please see the study for all other authors’ relevant financial disclosures.
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Paul L. Hess

Most PCIs for stable CAD performed in Veterans Affairs hospitals were classified as appropriate or may be appropriate, according to a study published in JAMA Network Open.

One in 10 of these procedures were considered rarely appropriate, according to the study.

“[The fact] that we still have some level of inappropriate procedures in this setting suggest that other factors may be operative including those related to patients, providers and health systems,” Paul L. Hess, MD, MHS, staff cardiologist at Rocky Mountain Regional VA Medical Center in Aurora, Colorado and assistant professor of medicine-cardiology at University of Colorado Anschutz Medical Campus in Aurora, told Healio.

Researchers analyzed data from 2,611 patients (mean age, 66 years; 99% men) with stable CAD who underwent elective PCI at 59 VA hospitals between November 2013 and October 2015. Appropriate use in this analysis was defined as the criteria issued in 2012 by the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions and other organizations.

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Breakdown of appropriateness of PCI procedures performed at VA hospitals.

Of the PCIs in this study, 29.8% were appropriate, 59.8% were may be appropriate and 10.4% were rarely appropriate.

Most PCIs classified as rarely appropriate were performed in patients with one coronary artery stenosis (68%) or were taking no (36.8%) or one antianginal medication (61.4%).

The median unadjusted hospital-level rate of rarely appropriate PCIs was 9.7% (95% CI, 6.3-13.9) and ranged from 0% to 28.6%. The estimated median rate of rarely appropriate PCI was 10.4% from random-effect models.

“Studies to understand factors underlying rates of appropriateness are needed,” Hess said in an interview. “Efforts to improve PCI appropriateness are similarly warranted.” – by Darlene Dobkowski

For more information:

Paul L. Hess, MD, MHS, can be reached at paul.hess@cuanschutz.edu.

Disclosures: Hess reports he received a grant from the U.S. Department of Veterans Affairs Health Services Research and Development. Please see the study for all other authors’ relevant financial disclosures.