Abstract 19640: Hospital Variation in Patient-Reported Outcomes in the Stable Coronary Artery Disease Population Undergoing Non-Emergent Percutaneous Coronary Intervention

• Published in: Circulation (New York, N.Y.) N.Y.), 2016-11, Vol.134 (Suppl_1 Suppl 1), p.A19640-A19640
• Main Authors: Rohde, Stefanie, Zribi, Rachelle, Wang, Yongfei, Arnold, Suzanne, Bernheim, Susannah, Dinkler, John, Jones, Phil, Lin, Zhenqiu, Loh, Kendall, Searfoss, Rana, Singleton, Erin, Spertus, John A, Suter, Lisa, Curtis, Jeptha
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionAmong patients with stable coronary artery disease (CAD), the primary goal of percutaneous coronary intervention (PCI) is to improve symptoms and quality of life. It is not known, however, to what extent patients vary in their improvement after PCI, nor whether the proportion of patients who improve varies across hospitals. We evaluated hospital variation in changes in patient-reported outcomes following elective PCI from baseline to 6 months using the Seattle Angina Questionnaire Short Form (SAQ-7) and Rose Dyspnea Scale (RDS).HypothesisWe hypothesized that there is substantial variation in symptom improvement after elective PCI and the proportion of patients who improve varies across hospitals.MethodsUsing data from a 10-center prospective registry of patients undergoing PCI between 2009 and 2011, we identified stable CAD patients who completed baseline and 6 month SAQ-7 and RDS surveys (n=1,121). We characterized improvement as a ≥5 point increase in SAQ-7 summary score or at least a 1 point decrease in RDS score without a ≥5 point decrease in SAQ-7. We calculated the proportion of patients who improved, and used hierarchical logistic regression models adjusting for body mass index, ejection fraction, and glomerular filtration rate to calculate risk-standardized improvement rates for each hospital.ResultsThe cohort’s mean age was 65.1 (SD 10.5) and 74.6% male. Overall, 76.4% of patients improved from baseline to 6 months, and there was substantial variation in both unadjusted and risk-standardized improvement rates (Table).ConclusionThese findings highlight an important performance gap and suggest a role for collecting patient-reported outcomes to promote shared decision making and reduce overuse of PCI.