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COURAGE trial affected geographic variation in PCI
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PCI use decreased in the wake of the COURAGE trial, according to recent findings published online. However, despite this decrease, investigators reported high rates of geographic variation in PCI use for stable ischemic heart disease.
The investigators said geographic variation may be caused by clinical uncertainty, but it remains unclear whether comparative effectiveness research can affect this variation. The current analysis is an investigation of whether geographic variation in the use of PCI for stable ischemic heart disease was affected by COURAGE trial results.
Sixty-seven hospital referral regions and 526 hospitals were included in the study, accounting for 272,659 PCIs for stable ischemic heart disease. Age- and sex-adjusted rates of PCI in the stable ischemic heart disease setting before 2006 and after 2008 were compared with contemporaneous changes in PCI volume for ACS.
A decrease of 25% in PCI volume for stable ischemic heart disease was reported for procedures conducted after the COURAGE trial (P<.001). A 12% decrease occurred for ACS after the trial (P<.001).
The investigators attributed the difference to changes in hospital referral regions. Volume decreased by 35% in the regions with the highest levels of utilization and 18% in the regions with the lowest levels of utilization.
Results of measurement using the systematic component of variation indicated that PCI for stable ischemic heart disease substantially varied by geographic location before COURAGE. A 28% decline occurred after the trial (0.53 vs. 0.4). However, even after publication of COURAGE, geographic variation was 0.4 for stable ischemic heart disease and 0.17 for ACS.
Disclosure: The researchers report no relevant financial disclosures.
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