Patient and hospital characteristics associated with inappropriate percutaneous coronary interventions
Paul S Chan1, Sunil V Rao2, Deepak L Bhatt3
1Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
Insights
Inappropriate percutaneous coronary interventions (PCI) were more common in men, white patients, and those with private insurance. These findings suggest potential overuse of PCI in these demographic groups.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Economics
Background:
- Previous research indicates disparities in percutaneous coronary intervention (PCI) rates among different demographic groups and insurance statuses.
- Specifically, Black patients, women, and individuals with public or no insurance were less likely to undergo PCI.
- The current study investigates whether this pattern is associated with overuse in certain populations, such as white patients, men, and those with private insurance.
Purpose of the Study:
- To determine if inappropriate percutaneous coronary intervention (PCI) rates vary based on patient demographic characteristics.
- To assess the association between insurance status and the likelihood of undergoing an inappropriate PCI.
- To identify potential disparities in PCI utilization and appropriateness.
Main Methods:
- Analysis of 221,254 nonacute PCIs from the National Cardiovascular Data Registry CathPCI Registry (July 2009 - March 2011).
- Appropriateness of PCI determined using the Appropriate Use Criteria for coronary revascularization.
- Multivariable hierarchical regression models employed to assess associations between demographics, insurance, and inappropriate PCI.
Main Results:
- 12.2% of nonacute PCIs (25,749 cases) were classified as inappropriate.
- Men and white patients showed higher odds of receiving inappropriate PCI compared to women and non-white patients, respectively.
- Patients with Medicare, other public insurance, or no insurance had lower odds of inappropriate PCI compared to those with private insurance.
Conclusions:
- Inappropriate percutaneous coronary interventions for nonacute indications were more prevalent in men, white individuals, and those with private insurance.
- These findings suggest that procedural overuse may contribute to higher PCI rates in these specific patient populations.
- Addressing demographic and insurance-related disparities is crucial for optimizing PCI utilization.
Objectives:
This study sought to examine whether rates of inappropriate percutaneous coronary intervention (PCI) differ by demographic characteristics and insurance status.
Background:
Prior studies have found that blacks, women, and those who have public or no health insurance are less likely to undergo PCI. Whether this reflects potential overuse in whites, men, and privately insured patients, in addition to underuse in disadvantaged populations, is unknown.
Methods:
Within the National Cardiovascular Data Registry CathPCI Registry, we identified 221,254 nonacute PCIs performed between July 2009 and March 2011. The appropriateness of PCI was determined using the Appropriate Use Criteria for coronary revascularization. Multivariable hierarchical regression was used to evaluate the association between patient demographics and insurance status and inappropriate PCI, as defined by the Appropriate Use Criteria.
Results:
Of 211,254 nonacute PCIs, 25,749 (12.2%) were classified as inappropriate. After multivariable adjustment, men (adjusted odd ratio [OR]: 1.08 [95% CI: 1.05 to 1.11]; p < 0.001) and whites (adjusted OR: 1.09 [95% CI: 1.05 to 1.14]; p < 0.001) were more likely to undergo an inappropriate PCI in comparison with women and nonwhites. Compared with privately insured patients, those who had Medicare (adjusted OR: 0.85 [95% CI: 0.83 to 0.88]), other public insurance (adjusted OR: 0.78 [95% CI: 0.73 to 0.83]), and no insurance (adjusted OR: 0.56 [95% CI: 0.50 to 0.61]) were less likely to undergo an inappropriate PCI (p < 0.001). In addition, compared with urban hospitals, those admitted at rural hospitals were less likely to undergo inappropriate PCI, whereas those at suburban hospitals were more likely.
Conclusions:
For nonacute indications, PCIs categorized as inappropriate were more commonly performed in men, whites, and those who had private insurance. Higher rates of PCI in these patient populations may, in part, be due to procedural overuse.
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