Variability in Coronary Artery Disease Testing for Patients With New-Onset Heart Failure.
Variability in Coronary Artery Disease Testing for Patients With New-Onset Heart Failure.
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DOI：
10.1016/j.jacc.2021.11.061
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发表时间：
2022-03-08
影响因子：
24
通讯作者：
Sandhu, Alexander T.
中科院分区：
文献类型：
--
作者：
Zheng, Jimmy;Heidenreich, Paul A.;Kohsaka, Shun;Fearon, William F.;Sandhu, Alexander T.
冠状动脉疾病（CAD）是新发心力衰竭（HF）的最常见原因。虽然指南建议在这一人群中进行缺血性评价，但该检测在历史上一直未得到充分利用。本研究旨在确定新发HF患者CAD检测的当代趋势，特别是在缺血性心力衰竭手术治疗扩展研究（STICHES）发表后，并描述检测模式的地理和临床医生水平变异性。我们使用涵盖商业保险和医疗保险的行政索赔数据库确定了2004-2019年接受CAD检测的HF患者的比例。我们确定了在初步诊断前后90天内CAD检测的人口统计学和临床预测因素。患者按其居住县分组，以评估国家差异。然后将患者与他们的初级保健医生和/或心脏病专家联系起来，以评估临床医生之间的差异。在558，322例新发HF患者中，34.8%接受了CAD检测，9.3%接受了血运重建。在多变量校正后，接受CAD检测的患者更可能是年轻、男性、在急性护理环境中诊断、有收缩功能障碍或近期心源性休克。CAD测试的发生率保持平稳，STICHES后无显著变化。协变量调整后的检验率在各县之间从20-45%不等。在由心脏病专家共同管理的患者中，测试的可能性较高（调整后OR 5.12，95% CI 4.98-5.27），但心脏病专家之间差异很大（IQR：50.9-62.4%）。住院和门诊的大多数新发HF患者没有及时接受CAD检测。各地区和临床医生之间的测试存在很大差异。新发心力衰竭（HF）患者的冠状动脉疾病（CAD）检测历来未得到充分利用。本研究利用一个大型的行政索赔数据库，以确定在住院和门诊设置之间，跨地区，临床医生之间的CAD测试的当代趋势。我们的研究结果表明，新发HF患者的CAD检测率仍然很低，即使在2016年缺血性心力衰竭手术治疗扩展研究发表后。住院和门诊的大多数新发HF患者没有及时接受CAD检测。临床医生和地理区域之间的检测率存在很大差异。
Coronary artery disease (CAD) is the most common cause of new-onset heart failure (HF). Although guidelines recommend ischemic evaluation in this population, testing has historically been underutilized. This study aimed to identify contemporary trends in CAD testing for new-onset HF patients, particularly after publication of the Surgical Treatment for Ischemic Heart Failure Extension Study (STICHES), and to characterize geographic and clinician-level variability in testing patterns. We determined the proportion of incident HF patients who received CAD testing from 2004–2019 using an administrative claims database covering commercial insurance and Medicare. We identified demographic and clinical predictors of CAD testing during the 90 days before and after initial diagnosis. Patients were grouped by their county of residence to assess national variation. Patients were then linked to their primary care physician and/or cardiologist to evaluate variation across clinicians. Among 558,322 new-onset HF patients, 34.8% underwent CAD testing and 9.3% underwent revascularization. After multivariable adjustment, patients who underwent CAD testing were more likely to be younger, male, diagnosed in an acute care setting, and have systolic dysfunction or recent cardiogenic shock. Incidence of CAD testing remained flat without significant change post-STICHES. Covariate-adjusted testing rates varied from 20–45% across counties. The likelihood of testing was higher among patients co-managed by a cardiologist (adjusted OR 5.12, 95% CI 4.98–5.27) but varied substantially across cardiologists (IQR: 50.9–62.4%). Most new-onset HF patients across inpatient and outpatient settings did not receive timely testing for CAD. Substantial variability in testing persists across regions and clinicians. Coronary artery disease (CAD) testing in patients with new-onset heart failure (HF) has historically been underutilized. The present study leverages a large administrative claims database to determine contemporary trends in CAD testing between inpatient and outpatient settings, across geographies, and among clinicians. Our results suggest that rates of CAD testing in new-onset HF patients remain low, even after publication of the Surgical Treatment for Ischemic Heart Failure Extension Study in 2016. Most new-onset HF patients across inpatient and outpatient settings did not receive timely testing for CAD. Substantial variability in testing rates persists across clinicians and geographic regions.
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DOI：
10.1161/circheartfailure.110.938175
发表时间：
2010-11
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Goyal A;Norton CR;Thomas TN;Davis RL;Butler J;Ashok V;Zhao L;Vaccarino V;Wilson PW
通讯作者：
Wilson PW
影响因子：
18.2
作者：
Ezekowitz, Justin A.;Kaul, Padma;McAlister, Finlay A.
通讯作者：
McAlister, Finlay A.
影响因子：
4.8
作者：
Flaherty, James D.;Rossi, Joseph S.;Gheorghiade, Mihai
通讯作者：
Gheorghiade, Mihai
影响因子：
24
作者：
Doshi, Darshan;Ben-Yehuda, Ori;Kirtane, Ajay J.
通讯作者：
Kirtane, Ajay J.
影响因子：
6.3
作者：
Clarke, Philippa;Wheaton, Blair
通讯作者：
Wheaton, Blair