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One-quarter of diagnostic catheterizations in N.Y. found inappropriate
Recent study results have concluded that one in four diagnostic catheterization procedures for suspected CAD in New York during a 2-year interval were inappropriate. Among the inappropriate procedures, two-thirds of the patients had no previous stress test.
The study, which was conducted by Edward L. Hannan, PhD, with the University of Albany, State University of New York, and colleagues, involved data from the New York State’s Cardiac Diagnostic Catheterization Database. In all, 8,986 patients from 18 New York hospitals underwent diagnostic catheterization for suspected CAD from 2010 to 2011.
Researchers rated patients as appropriate, uncertain and inappropriate based on the appropriate use criteria (AUC) for diagnostic catheterization published in 2012 by the American College of Cardiology Foundation and other professional societies.
Edward L. Hannan
According to results, 24.9% of patients were rated as inappropriate, with 35.3% being considered appropriate and 39.8% uncertain. Of the inappropriate patients, 56.7% had no previous stress test, were asymptomatic and had low or intermediate global CAD risk. Additionally, 36% of these patients had a previous stress test with low-risk findings and no symptoms, and 7.3% were symptomatic, had no previous stress test and had low pretest probability.
Further analysis revealed that the median hospital-level inappropriateness rate was 28.5%, with a maximum of 48.8% and a minimum of 8.6%, and hospital-level inappropriateness did not correlate with hospital volume or inappropriateness for PCI.
However, Hannan and colleagues noted several caveats with their study, including the inherent complication of applying the AUC to individual clinical decisions because the criteria are unable to capture every important consideration.
“It should also be noted that AUC for [diagnostic catheterizations] and PCI are an evolving process, and a new nomenclature change has been approved but not yet published. This could have a bearing on how the AUC should be interpreted and used,” they wrote.
Disclosure: One researcher reports financial disclosures with Abbott, Angioscore, Boston Scientific, Daiichi Sankyo/Eli Lilly and The Medicines Company, and another reports serving on the data safety monitoring board for Merck & Company, nContact Surgical and Wyeth Pharmaceuticals, and as a consultant for CeloNova BioSciences. The other researchers report no relevant financial disclosures.