Variation in Management of Patients With Obstructive Coronary Artery Disease: Insights From the Veterans Affairs Clinical Assessment and Reporting Tool (VA CART) Program
Variation in Management of Patients With Obstructive Coronary Artery Disease: Insights From the Veterans Affairs Clinical Assessment and Reporting Tool (VA CART) Program
复制标题
阻塞性冠状动脉疾病患者管理的变化：来自退伍军人事务部临床评估和报告工具 (VA CART) 计划的见解
DOI：
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
S. Bradley
中科院分区：
文献类型：
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作者：
Amneet Sandhu;Maggie A. Stanislawski;G. Grunwald;Kathryn Guinn;J. Valle;D. Matlock;P. Ho;T. Maddox;S. Bradley
背景在稳定型阻塞性冠状动脉疾病的血管重建术治疗中，设施水平的差异知之甚少。此外，目前尚不清楚冠状动脉血管重建术的使用是否与其他心血管手术的使用有关。方法和结果我们使用临床评估和报告工具评估了2007年9月1日至2011年12月31日期间在退伍军人事务系统进行的所有选择性冠状动脉造影术，并确定了阻塞性冠状动脉疾病的患者。如果患者在确诊后30天内接受了经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术，则认为他们接受了血管重建术。我们计算了风险调整设施水平的总体血运重建、经皮冠状动脉介入治疗和冠状动脉旁路移植术的比率。此外，我们还确定了设施水平的血运重建率与冠状动脉介入术后负荷测试之间的关系。在51个退伍军人事务部符合纳入标准的15650名患者中，血管重建率的中位数为59.6%(四分位数范围为55.7%-66.7%)。风险调整率为41.5%~88.1%，冠状动脉介入治疗率为23.2%~80.6%，冠状动脉搭桥率为7.5%~36.5%。在6179名接受择期经皮冠状动脉介入治疗的患者中，在术后2年内进行负荷测试的中位数为33.7%(四分位数范围为30.7%-47.1%)。没有证据表明设施水平的血管重建率和后续的压力测试之间存在相关性。结论：在退伍军人事务系统中，我们观察到阻塞性冠状动脉疾病的血运重建率在设施水平上有很大的差异，这种差异主要是由经皮冠状动脉介入治疗所驱动的。设备级别的血管重建使用与后续压力测试之间没有关联，这表明使用率特定于特定的程序，而不是总体设备级别使用的标志。
Background Little is known about facility‐level variation in the use of revascularization procedures for the management of stable obstructive coronary artery disease. Furthermore, it is unknown if variation in the use of coronary revascularization is associated with use of other cardiovascular procedures. Methods and Results We evaluated all elective coronary angiograms performed in the Veterans Affairs system between September 1, 2007, and December 31, 2011, using the Clinical Assessment and Reporting Tool and identified patients with obstructive coronary artery disease. Patients were considered managed with revascularization if they received percutaneous coronary intervention (PCI) or coronary artery bypass grafting within 30 days of diagnosis. We calculated risk‐adjusted facility‐level rates of overall revascularization, PCI, and coronary artery bypass grafting. In addition, we determined the association between facility‐level rates of revascularization and post‐PCI stress testing. Among 15 650 patients at 51 Veterans Affairs sites who met inclusion criteria, the median rate of revascularization was 59.6% (interquartile range, 55.7%–66.7%). Across all facilities, risk‐adjusted rates of overall revascularization varied from 41.5% to 88.1%, rate of PCI varied from 23.2% to 80.6%, and rate of coronary artery bypass graftingvariedfrom 7.5% to 36.5%. Of 6179 patients who underwent elective PCI, the median rate of stress testing in the 2 years after PCI was 33.7% (interquartile range, 30.7%–47.1%). There was no evidence of correlation between facility‐level rate of revascularization and follow‐up stress testing. Conclusions Within the Veterans Affairs system, we observed large facility‐level variation in rates of revascularization for obstructive coronary artery disease, with variation driven primarily by PCI. There was no association between facility‐level use of revascularization and follow‐up stress testing, suggesting use rates are specific to a particular procedure and not a marker of overall facility‐level use.
影响因子：
120.7
作者：
Epstein, Andrew J.;Polsky, Daniel;Yang, Feifei;Yang, Lin;Groeneveld, Peter W.
通讯作者：
Groeneveld, Peter W.