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[Too many heart catheter procedures in Germany ?].

M Gottwik1, U Zeymer, S Schneider

  • 1Klinikum Nürnberg Süd, Medizinische Klinik 8, Nürnberg, Germany. gottwik@klinikum-nuernberg.de

Deutsche Medizinische Wochenschrift (1946)
|October 10, 2003
PubMed
Summary

Absolute numbers of cardiovascular procedures in Germany are not an indicator of overuse. Comparing diagnostic cardiac catheterizations and revascularization rates across Europe reveals no direct relationship, suggesting a need for standardized criteria to assess procedure appropriateness.

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Area of Science:

  • Cardiovascular medicine
  • Health services research
  • Interventional cardiology

Background:

  • Germany exhibits higher absolute numbers of cardiovascular procedures compared to other European nations.
  • This disparity has led to arguments suggesting overuse of cardiac interventions in Germany.
  • Alternative indicators for assessing the appropriate use of cardiovascular resources are therefore needed.

Purpose of the Study:

  • To compare the relationship between diagnostic cardiac catheterizations and subsequent revascularization procedures across eight European countries.
  • To evaluate the indication criteria for cardiac catheterizations in a large German patient registry.

Main Methods:

  • Comparative analysis of diagnostic cardiac catheterizations and revascularization rates in eight European countries.

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  • Review of indication criteria within a German registry of 205,581 consecutive inpatients undergoing cardiac catheterization.

    • Main Results:

    • Revascularization rates post-diagnostic cardiac catheterization varied from 39.1% to 57.9% across eight European countries, with Germany at 43.2%.
    • No correlation was found between the absolute volume of diagnostic procedures and the percentage of subsequent revascularizations.
    • In the German registry, key indications included Acute Coronary Syndrome (22.9%) and varying CCS classes of angina pectoris (CCS II/III: 80.3%, CCS IV: 17.2%).

    Conclusions:

    • Absolute procedure numbers are insufficient indicators for evaluating the overuse of cardiovascular interventions.
    • Establishing standardized data acquisition protocols at European, national, and regional levels is crucial.
    • Developing validation procedures for indication criteria is necessary to appropriately assess invasive cardiac procedures across diverse healthcare systems.