Appropriateness Criteria for Coronary Revascularization: Measurement and Validity

冠状动脉血运重建的适当性标准：测量和有效性

• 批准号: 8629624
• 负责人: Paul Sheung-Yan Chan
• 金额: $ 11.62万
• 依托单位: SAINT LUKE'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-01 至 2016-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8629624
• 关键词: Accounting; Adopted; Adoption; Algorithms; American; American Heart Association; Angiography; Angioplasty; Atlases; Balloon Angioplasty; Bypass; Cardiac; Cardiology; Cardiovascular system; Caring; Case Report Form; Clinical; Clinical Trials; Coronary; Coronary Arteriosclerosis; Data; Data Collection; Data Element; Decision Aid; Derivation procedure; Development; Documentation; Enrollment; Expert Opinion; Foundations; Frequencies; Funding; Future; Gender; Goals; Grant; Health; Health Status; Healthcare; Heart; Hospital Referrals; Hospitals; Image; Incentives; Individual; Institution; Judgment; Link; Maps; Measurement; Measures; Medicare; Methods; Multicenter Studies; Myocardial; Operative Surgical Procedures; Outcome; Patient Selection; Patients; Pharmaceutical Preparations; Pharmacotherapy; Physicians; Policy Maker; Prevalence; Procedures; Prospective Studies; Publishing; Quality of life; Questionnaires; Recommendation; Registries; Relative (related person); Research; Research Personnel; Research Project Grants; Rest; Series; Site; Societies; Specialist; Stents; Surgeon; Symptoms; System; Techniques; Testing; Update; Validation; Variant; Weight; Work; adjudicate; base; beneficiary; clinical care; clinical practice; college; data registry; design; follow-up; improved; insight; instrument; member; men; patient oriented; percutaneous coronary intervention; repository; response; routine practice; sound; tool

DESCRIPTION (provided by applicant): The American College of Cardiology (ACC) has recently developed Appropriateness Criteria (AC) for coronary revascularization to support the rational and judicious use of percutaneous coronary intervention (PCI). Because a modified Delphi approach was used, there is an absence of clinical evidence to support the appropriateness ratings for most of the AC scenarios. This proposal will test the feasibility of applying the AC in routine clinical practice, assess variations in rates of appropriate and inappropriate PCI use nationally, and examine whether the AC are associated with objective measures of patient-centered benefit. These aims are aligned with the NIH's priorities of improving the efficiency and appropriateness of care. Specific Aim 1 will examine the feasibility of applying the AC in clinical practice. Data templates that capture the requisite patients' clinical, medication, imaging, and angiographic data for the AC will be developed and prospectively implemented in a 4-center study. In addition, the National Cardiovascular Data Registry (NCDR) Cath/PCI data collection tool will be modified to capture the necessary AC data elements. Finally, linking algorithms to map individual PCI procedures to the AC will be developed. Specific Aim 2 will describe the prevalence of and variations in PCI appropriateness across hospitals participating in the NCDR Cath/PCI registry. This analysis will provide national prevalence estimates of PCI procedures that are rated appropriate, inappropriate, or uncertain, per the AC; examine the variability in the proportion of appropriate and inappropriate PCIs across institutions; and determine the degree to which overuse may account for wide variations in PCI use by correlating rates of inappropriate and uncertain PCIs within Medicare Hospital Referral Regions with variability in overall PCI use from the Dartmouth Atlas. Specific Aim 3 will validate the ratings of the AC with objective measurements of patient benefit. Through a 4-center prospective study, 6-month changes in angina symptoms and quality of life will be assessed with the Seattle Angina Questionnaire (SAQ) and the EQ-5D instruments. Measurements of change in symptom burden and quality of life will then be correlated with ratings of appropriateness to determine if the AC are associated with objective measures of clinical benefit. Specific Aim 4 will involve derivation of a shortened SAQ to facilitate its use in routine practice. As patients' symptoms are a critical determinant of the AC ratings, and as assignment of patients' symptom status by physicians can be highly variable, direct assessment of symptoms from patients' responses to the SAQ offers the opportunity for substantially greater reliability and fidelity. However, the full SAQ is too cumbersome to routinely collect in clinical practice. Using the extensive repository of SAQ data at our institution, a parsimonious SAQ will be derived and validated to facilitate its use in routine practice. PROJECT NARRATIVE: Recently, criteria which assess whether a balloon angioplasty or heart stent procedure is appropriate for a patient have been published by cardiology professional societies. These criteria, however, are primarily based on expert opinion rather than scientific evidence. Because these appropriateness criteria may be used to influence future decisions on angioplasty and stent procedures, this research project will validate these criteria and examine whether they are feasible to implement.

描述(由申请人提供)：美国心脏病学会(ACC)最近制定了冠状动脉血运重建的适宜性标准(AC)，以支持合理和明智地使用经皮冠状动脉介入治疗(PCI)。由于使用了改进的Delphi方法，因此缺乏临床证据来支持大多数AC方案的适宜性评级。这项建议将测试AC在常规临床实践中应用的可行性，评估全国适当和不适当的PCI使用率的差异，并检查AC是否与以患者为中心的利益的客观衡量标准有关。这些目标与NIH提高护理效率和适当性的优先事项一致。具体目标1将考察AC在临床实践中应用的可行性。将开发数据模板，获取AC所需的患者的临床、用药、成像和血管造影数据，并在一项4中心研究中进行前瞻性实施。此外，国家心血管数据登记处(NCDR)Cath/PCI数据收集工具将进行修改，以捕获必要的AC数据元素。最后，将开发将单个PCI程序映射到AC的链接算法。具体目标2将描述参与NCDR Cath/PCI登记的医院之间的PCI适宜性的流行率和变化。这项分析将根据AC提供适当、不适当或不确定的PCI手术的全国流行率估计；检查机构中适当和不适当的PCI比例的变异性；通过将Medicare医院转介区域内不适当和不确定的PCI的比率与达特茅斯地图集中的总体PCI使用的变异性相关联，确定过度使用可能导致PCI使用的巨大差异的程度。具体目标3将通过客观衡量患者的利益来验证AC的评级。通过4个中心的前瞻性研究，将使用西雅图心绞痛问卷(SAQ)和EQ-5D工具评估6个月来心绞痛症状和生活质量的变化。然后，症状负担和生活质量变化的测量将与适宜性评级相关联，以确定AC是否与临床益处的客观测量相关联。具体目标4将涉及推导一个缩短的SAQ，以便利其在日常实践中的使用。由于患者的症状是AC评级的关键决定因素，而且医生对患者的症状状态的分配可能具有高度的变异性，因此根据患者对SAQ的反应直接评估症状提供了大幅提高可靠性和保真度的机会。然而，完整的SAQ过于繁琐，无法在临床实践中常规收集。利用我们机构的大量SAQ数据，将得出并验证简明的SAQ，以促进其在日常实践中的使用。 项目简介：最近，心脏病学专业学会公布了评估球囊血管成形术或心脏支架手术是否适合患者的标准。然而，这些标准主要是基于专家的意见，而不是科学证据。由于这些适当性标准可能被用来影响未来血管成形术和支架手术的决策，本研究项目将验证这些标准并检查它们是否可行。

项目成果

Carotid artery stenting of a contralateral occlusion and in-hospital outcomes: results from the CARE (Carotid Artery Revascularization and Endarterectomy) registry.

对侧闭塞的颈动脉支架置入术和院内结果：来自 CARE（颈动脉血运重建和动脉内膜切除术）登记处的结果。

• DOI: 10.1016/j.jcin.2012.09.009
• 发表时间: 2013
• 期刊: JACC. Cardiovascular interventions
• 作者: Mercado,Nestor;Cohen,DavidJ;Spertus,JohnA;Chan,PaulS;House,John;Kennedy,Kevin;Brindis,RalphG;White,ChristopherJ;Rosenfield,KennethA;Marso,StevenP
• 通讯作者: Marso,StevenP

Appropriateness of percutaneous coronary intervention.

• DOI: 10.1001/jama.2011.916
• 发表时间: 2011-07-06
• 期刊: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
• 影响因子: 120.7
• 作者: Chan, Paul S.;Patel, Manesh R.;Klein, Lloyd W.;Krone, Ronald J.;Dehmer, Gregory J.;Kennedy, Kevin;Nallamothu, Brahmajee K.;Weaver, W. Douglas;Masoudi, Frederick A.;Rumsfeld, John S.;Brindis, Ralph G.;Spertus, John A.
• 通讯作者: Spertus, John A.

A combined anatomic and electrophysiologic substrate based approach for sudden cardiac death risk stratification.

• DOI: 10.1016/j.ahj.2013.06.023
• 发表时间: 2013-10
• 期刊: AMERICAN HEART JOURNAL
• 影响因子: 4.8
• 作者: Merchant, Faisal M.;Zheng, Hui;Bigger, Thomas;Steinman, Richard;Ikeda, Takanori;Pedretti, Roberto F. E.;Salerno-Uriarte, Jorge A.;Klersy, Catherine;Chan, Paul S.;Bartone, Cheryl;Hohnloser, Stefan H.;Ruskin, Jeremy N.;Armoundas, Antonis A.
• 通讯作者: Armoundas, Antonis A.

Treatment differences by health insurance among outpatients with coronary artery disease: insights from the national cardiovascular data registry.

• DOI: 10.1016/j.jacc.2012.11.058
• 发表时间: 2013-03-12
• 期刊: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
• 影响因子: 24
• 作者: Smolderen, Kim G.;Spertus, John A.;Tang, Fengming;Oetgen, William;Borden, William B.;Ting, Henry H.;Chan, Paul S.
• 通讯作者: Chan, Paul S.

Body mass index and survival after in-hospital cardiac arrest.

• DOI: 10.1161/circoutcomes.109.912501
• 发表时间: 2010-09
• 期刊: Circulation. Cardiovascular quality and outcomes
• 作者: Jain R;Nallamothu BK;Chan PS;American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) investigators
• 通讯作者: American Heart Association National Registry of Cardiopulmonary Resuscitation (NRCPR) investigators