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Variations in coronary procedure utilization depending on body mass index
William S Yancy1, Maren K Olsen, Lesley H Curtis
1Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC 27705, USA. yancy006@mc.duke.edu
Insights
Higher body mass index (BMI) is linked to lower use of invasive heart procedures after heart attack. Patients with very high BMI were less likely to receive cardiac catheterization or bypass surgery.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Increased body mass index (BMI) is a known risk factor for coronary heart disease.
- Higher BMI is associated with reduced utilization of preventive cardiac services.
- The impact of BMI on diagnostic and therapeutic procedures for coronary heart disease remains understudied.
Purpose of the Study:
- To investigate the relationship between body mass index (BMI) and the utilization of key invasive coronary procedures.
- To examine how different BMI categories affect the likelihood of receiving cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass grafting in patients hospitalized for acute myocardial infarction.
Main Methods:
- Analysis of Medicare patient data (109,664 individuals) hospitalized for acute myocardial infarction between 1994-1996.
- Logistic regression used to assess the association between BMI and the utilization of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass grafting.
- Adjustments made for patient and hospital characteristics to isolate the effect of BMI.
Main Results:
- Patients with BMI between 25.0 and 35.0 demonstrated the highest rates of coronary procedure utilization.
- Individuals with a BMI of 35.0 to 39.9 had lower odds of undergoing coronary artery bypass grafting (OR, 0.88).
- Patients with a BMI of 40.0 or greater exhibited significantly lower odds for cardiac catheterization (OR, 0.82) and coronary artery bypass grafting (OR, 0.68).
Conclusions:
- Very high body mass index (BMI) is associated with decreased likelihood of receiving invasive coronary procedures among patients hospitalized with acute myocardial infarction.
- Significant disparities in the utilization of cardiac procedures exist based on patient BMI.
- Further research is warranted to understand the underlying reasons for these variations in care delivery and utilization.
Background:
Increased body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) is a risk factor for coronary heart disease and is associated with lower preventive services utilization. The relationship between BMI and utilization of diagnostic or therapeutic procedures for coronary heart disease has not been examined.
Methods:
We evaluated 109 664 Medicare patients who were hospitalized for acute myocardial infarction in a nongovernmental acute care hospital between 1994 and 1996, were 65 years or older, and weighed 159 kg or less. We used logistic regression to examine the relationship of BMI with utilization of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass grafting while adjusting for patient and hospital characteristics.
Results:
Participants had a mean age of 75.8 years; 53% were men and 90% were white. Individuals with a BMI of 25.0 to 35.0 had the highest rates of coronary procedure utilization. Compared with patients with a BMI of 25.0 to 29.9, those with a BMI of 35.0 to 39.9 had a reduced adjusted odds ratio (OR) of receiving coronary artery bypass grafting (OR, 0.88; 95% confidence interval [CI], 0.79-0.98), whereas patients with a BMI of 40.0 or greater had the lowest odds of receiving cardiac catheterization (OR, 0.82; 95% CI, 0.73-0.92), percutaneous coronary intervention (OR, 0.89; 95% CI, 0.77-1.03), and coronary artery bypass grafting (OR, 0.68; 95% CI, 0.57-0.82). Patients who did not receive coronary revascularization had higher mortality rates than those who did.
Conclusions:
For patients hospitalized with acute myocardial infarction, those with a very high BMI were less likely to receive invasive coronary procedures. Future research should investigate reasons for these variations in coronary procedure utilization.
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