Patient and Hospital Characteristics Associated With Inappropriate Percutaneous Coronary Interventions

• Published in: Journal of the American College of Cardiology 2013-12, Vol.62 (24), p.2274-2281
• Main Authors: Chan, Paul S., MD, MSc, Rao, Sunil V., MD, Bhatt, Deepak L., MD, MPH, Rumsfeld, John S., MD, PhD, Gurm, Hitinder S., MD, Nallamothu, Brahmajee K., MD, MPH, Cavender, Matthew A., MD, MPH, Kennedy, Kevin F., MS, Spertus, John A., MD
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Black or African American; Black People - statistics & numerical data; Cardiology; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Diseases of the cardiovascular system; disparities; Female; Health insurance; Health Services Research; Heart; Heart attacks; Hospitals; Hospitals - statistics & numerical data; Humans; Insurance, Health - statistics & numerical data; Internal Medicine; Male; Medical Assistance - statistics & numerical data; Medical sciences; Medically Uninsured - statistics & numerical data; Multivariate Analysis; overuse; Patient Selection; PCI; Percutaneous Coronary Intervention - statistics & numerical data; quality of care; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Registries; Sex Factors; Studies; United States; White People - statistics & numerical data
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2013.07.086

Objectives This study sought to examine whether rates of inappropriate percutaneous coronary intervention (PCI) differ by demographic characteristics and insurance status. Background Prior studies have found that blacks, women, and those who have public or no health insurance are less likely to undergo 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 National Cardiovascular Data Registry CathPCI Registry, we identified 221,254 nonacute PCIs performed between July 2009 and March 2011. The appropriateness of PCI was determined using the Appropriate Use Criteria for coronary revascularization. Multivariable hierarchical regression was used to evaluate the association between patient demographics and insurance status and inappropriate PCI, as defined by the Appropriate Use Criteria. Results Of 211,254 nonacute PCIs, 25,749 (12.2%) were classified as inappropriate. After multivariable adjustment, men (adjusted odd ratio [OR]: 1.08 [95% CI: 1.05 to 1.11]; p < 0.001) and whites (adjusted OR: 1.09 [95% CI: 1.05 to 1.14]; p < 0.001) were more likely to undergo an inappropriate PCI in comparison with women and nonwhites. Compared with privately insured patients, those who had Medicare (adjusted OR: 0.85 [95% CI: 0.83 to 0.88]), other public insurance (adjusted OR: 0.78 [95% CI: 0.73 to 0.83]), and no insurance (adjusted OR: 0.56 [95% CI: 0.50 to 0.61]) were less likely to undergo an inappropriate PCI (p < 0.001). In addition, compared with urban hospitals, those admitted at rural hospitals were less likely to undergo inappropriate PCI, whereas those at suburban hospitals were more likely. Conclusions For nonacute indications, PCIs categorized as inappropriate were more commonly performed in men, whites, and those who had private insurance. Higher rates of PCI in these patient populations may, in part, be due to procedural overuse.