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Prognostic impact of different regional referral practices for interventional investigation and coronary treatment
T Niemann1, R Labouriau, H Toft Sørensen
1Department of Medicine, Herning Hospital, Herning, Denmark. t.niemann@dadlnet.dk
Insights
Different referral rates for coronary angiography after exercise tests did not impact patient mortality or myocardial infarction. This study found no significant differences in outcomes regardless of center practices for invasive procedures.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Health Services Research
Background:
- Exercise testing is a common method to assess patients with suspected coronary artery disease.
- Referral practices for coronary angiography (CAG) vary significantly between healthcare centers.
- Understanding the impact of these referral variations on patient outcomes is crucial for optimizing care.
Purpose of the Study:
- To investigate the association between different centers' referral practices for CAG following exercise testing and patient outcomes.
- To compare 1-year and 5-year mortality and myocardial infarction (MI) rates based on referral fractions.
Main Methods:
- Observational, population-based cohort study including 736 patients with abnormal exercise tests.
- Data collected from 10 hospitals and 6 private consultants in Denmark.
- Categorized centers into low, intermediate, and high referral fractions for CAG.
Main Results:
- No significant differences in 5-year all-cause mortality, cardiovascular mortality, or myocardial infarction (MI) were observed between centers with low, intermediate, and high referral fractions for CAG.
- Similar findings were noted at the 1-year follow-up, indicating no major differences in mortality or MI rates among centers.
Conclusions:
- Variations in referral practices for coronary angiography among different centers are not significantly associated with short-term or long-term mortality or myocardial infarction in patients with abnormal exercise tests.
- Clinical outcomes appear consistent across centers despite differing approaches to invasive cardiac investigations.
Objective:
To examine the association among different centres' referral practices for coronary angiography (CAG) after exercise testing, with 1- and 5-year outcomes.
Design:
Observational population-based cohort study.
Setting:
All 10 hospitals and six private practising consultants in Aarhus and Ringkjoebing counties (900 000 inhabitants), Denmark.
Subjects:
All patients who in 1996 had an abnormal bicycle exercise test (n = 736).
Measurements:
Referral for CAG, coronary intervention, cardiovascular and all-cause mortality, and myocardial infarction (MI).
Results:
As an immediate consequence of the exercise test, 60.7% of subjects were referred for CAG. Based on the centres' fraction of patients referred for CAG, three categories of centres were defined: low (<33%), intermediate (33-66%) and high (>66%). A low compared with a high referral fraction was associated with a similar 5-year mortality and MI ratio [all-cause/cardiovascular mortality rate ratio (RR) = 1.33, 95% confidence interval (CI): 0.45-3.92/RR = 0.62, 95% CI: 0.25-1.57; and MI RR = 0.92, 95% CI: 0.45-1.86]. The same was found for an intermediate compared with a high fraction (all-cause/cardiovascular mortality RR = 0.92, 95% CI: 0.49-1.72/RR = 0.74, 95% CI: 0.42-1.33; and MI RR = 1.07, 95% CI: 0.68-1.70). Estimates were about the same after 1 year of follow-up with no major differences among centres in mortality or MI.
Conclusions:
Centres' different referral practices for interventional investigation and treatment were not associated significantly with short-term or long-term mortality or MI among patients with an abnormal exercise test.
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