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Appropriateness of invasive cardiovascular interventions in German hospitals (2000-2001): an evaluation using the
Afschin Gandjour1, Iris Neumann, Karl Wilhelm Lauterbach
1Institute of Health Economics and Clinical Epidemiology, University of Cologne, Gleueler Strasse 176-178, 50935 Cologne, Germany. afschin.gandjour@medizin.uni-koeln.de
Insights
German hospitals show low overt overuse of percutaneous transluminal coronary angioplasties (PTCAs), coronary artery bypass grafts (CABGs), and carotid endarterectomies (CEAs). However, there may be significant underuse of pre-interventional stress tests.
Area of Science:
- Cardiovascular medicine
- Health services research
- Medical procedure appropriateness
Background:
- Germany exhibits high rates of percutaneous transluminal coronary angioplasty (PTCA) and heart surgeries.
- Evaluating the appropriateness of invasive cardiovascular procedures is crucial for healthcare quality.
Purpose of the Study:
- To assess the appropriateness of PTCA, coronary artery bypass graft (CABG), and carotid endarterectomy (CEA) in German hospitals.
- To compare German procedure rates with international benchmarks.
Main Methods:
- Retrospective study involving 121 randomly selected German hospitals.
- Analysis of 361 patient cases, including 128 PTCAs, 92 CABGs, and 141 CEAs.
- Utilized RAND appropriateness criteria for evaluation.
Main Results:
- Low inappropriateness rates: 2% for PTCA, 4% for CABG, and 3% for CEA.
- A high rate of uncertain procedures (42%) was observed.
- Only 38% of patients undergoing coronary intervention had a pre-interventional stress test.
Conclusions:
- Minimal overt overuse of PTCA, CABG, and CEA in Germany.
- Potential underuse of pre-interventional stress tests requires attention.
- Inappropriate procedure rates are comparable to other countries despite high intervention rates.
Objective:
Germany has the highest per capita rate of percutaneous transluminal coronary angioplasties (PTCAs) in Europe and the third highest per capita rate of heart surgeries requiring a heart-lung machine. The goal of this study was to evaluate the appropriateness of PTCA, coronary artery bypass graft (CABG), and carotid endarterectomy (CEA) in German hospitals using RAND appropriateness criteria.
Methods:
A retrospective study in 121 randomly selected German hospitals (52% of all hospitals contacted) was performed from December 2000 to August 2001. A total of 361 patients were enrolled providing information on the appropriateness of 128 PTCAs, 92 CABGs, and 141 CEAs.
Results:
Inappropriateness rates were 2% (95% CI 0-5%), 4% (95% CI 1-9%), and 3% (95% CI 1-7%) for PTCA, CABG, and CEA, respectively. The overall rate of uncertain procedures was 42% (95% CI 36-47%). Only 38% (95% CI 32-45%) of patients who received a coronary intervention had had a pre-interventional stress test.
Conclusions:
The study yielded little overt overuse in the performance of PTCAs, CABGs, and CEAs, but potentially large underuse of stress tests. Despite a high per capita rate of invasive cardiovascular interventions in Germany, the rate of inappropriate procedures was not larger than in other countries.
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