Underutilization of Coronary Artery Disease Testing Among Patients Hospitalized With New-Onset Heart Failure
Underutilization of Coronary Artery Disease Testing Among Patients Hospitalized With New-Onset Heart Failure
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DOI：
10.1016/j.jacc.2016.05.060
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发表时间：
2016-08-02
影响因子：
24
通讯作者：
Kirtane, Ajay J.
中科院分区：
文献类型：
--
作者：
Doshi, Darshan;Ben-Yehuda, Ori;Kirtane, Ajay J.
背景虽然缺血性冠状动脉疾病（CAD）是心力衰竭（HF）最常见的病因，新发HF患者实际接受缺血性检查和/或血运重建的程度还没有很好的定义。方法：这是一项回顾性队列研究，使用2010年至2013年的Truven Health MarketScan商业和医疗保险数据库。在住院期间和入院后90天内，对新发住院HF诊断的患者进行了无创和有创缺血性CAD检测和血运重建检查。结果在住院期间确诊为新发HF的67，161例患者中，只有17.5%的患者在住院期间接受了缺血性CAD检测，90天时增加到27.4%。在新发HF患者中，仅2.1%在HF住院期间接受了血运重建;到90天时，血运重建率增加至4.3%。在针对缺血性CAD进行的检查中，7.9%的新发HF患者在首次住院期间（14.6%在90天内）进行了负荷试验（核负荷试验或负荷超声心动图），而11.1%的患者在首次住院期间（16.5%在90天内）进行了冠状动脉造影。在校正分析中，基线诊断为CAD的HF患者进行无创缺血性检查的几率更大（比值比：1.25; 95%置信区间：1.17至1.33; p < 0.0001），以及侵入性缺血试验（比值比：1.93; 95%可信区间：1.83 ~ 2.05; p < 0.0001），在指数住院比那些没有基线CAD。结论大多数新发HF住院的患者在住院期间或90天内没有接受缺血性CAD的测试，这表明缺血性CAD评估在新发HF患者中的显著利用不足。(C)2016年由美国心脏病学会基金会。
BACKGROUND Although ischemic coronary artery disease (CAD) is the most common etiology of heart failure (HF), the extent to which patients with new-onset HF actually undergo an ischemic work-up and/or revascularization is not well defined.OBJECTIVES This study sought to analyze the patterns of testing for ischemic CAD and revascularization in patients with new-onset HF.METHODS This was a retrospective cohort study using Truven Health MarketScan Commercial and Medicare databases from 2010 to 2013. The occurrence of noninvasive and invasive ischemic CAD testing and revascularization procedures were examined among patients with new inpatient HF diagnoses during the index hospitalization and within 90 days of admission.RESULTS Among 67,161 patients identified with new-onset HF during an inpatient hospitalization, only 17.5% underwent testing for ischemic CAD during the index hospitalization, increasing to 27.4% at 90 days. Among patients with new-onset HF, only 2.1% underwent revascularization during the index hospitalization for HF; by 90 days, the revascularization rate had increased to 4.3%. Of the tests performed for ischemic CAD, stress testing (nuclear stress testing or stress echocardiography) was performed in 7.9% of new-onset HF patients during the index hospitalization (14.6% within 90 days), whereas coronary angiography was performed in 11.1% of patients during the index hospitalization (16.5% within 90 days). In adjusted analyses, HF patients carrying a baseline diagnosis of CAD had greater odds of noninvasive ischemic testing (odds ratio: 1.25; 95% confidence interval: 1.17 to 1.33; p < 0.0001), as well as invasive ischemic testing (odds ratio: 1.93; 95% confidence interval: 1.83 to 2.05; p < 0.0001), at the index hospitalization than those without baseline CAD.CONCLUSIONS The majority of patients hospitalized for new-onset HF did not receive testing for ischemic CAD either during hospitalization or within 90 days, which suggests significant underutilization of ischemic CAD assessment in new-onset HF patients. (C) 2016 by the American College of Cardiology Foundation.