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Stress testing after PCI varies across VA hospitals
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Of more than 10,000 patients who underwent PCI at Veterans Affairs hospitals, only 22% had a stress test within 1 year and 38% within 2 years, researchers reported in a new study.
“Stress testing after PCI in fee-for-service settings is common and rates vary by hospital. Rates of stress testing after PCI within integrated health care systems, such as the VA, are unknown,” Steven M. Bradley, MD, MPH, from the VA Eastern Colorado Health Care System in Denver and a Cardiology Today’s Intervention Editorial Board member, and colleagues wrote.
The researchers evaluated data on 10,293 patients who underwent PCI at 55 VA hospitals from October 2007 to June 2010. Individuals covered by Medicare were excluded.
Eighty percent of the stress tests were performed with nuclear imaging, 16.2% with no imaging, 3.8% with echocardiography and less than 0.1% with MRI.
More than 14% of patients who underwent stress testing within 2 years after PCI had repeat coronary angiography before the test and 6.9% had repeat PCI before the test. Within 3 months after follow-up stress testing, 19.3% of patients underwent coronary angiography and 9.1% underwent PCI.
Fourteen hospitals had risk-standardized stress-testing rates that were significantly different from the average. Eight hospitals (14.5%) were below the national standard and six hospitals (10.9%) were above the national standard. The risk-standardized rates ranged from 28.5% to 55.2%, according to the results.
The researchers found no significant correlation between hospital-level risk-standardized stress testing rates and mortality or MI.
According to the researchers, the rate of stress testing observed in this study is one-third less than that reported in previous studies at other U.S. hospitals.
“These findings suggest that opportunities to optimize the use of stress testing are still present in integrated health care systems,” Bradley and colleagues concluded. “Addressing the causes and consequences of variation in stress test use in the VA may have implications for other established and emerging non fee-for-service care delivery organizations.” – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.
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