Moving from volume to value for revascularization in stable ischemic heart disease: A review

Area of Science:

• Cardiovascular Medicine
• Health Policy
• Healthcare Management

Background:

• Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are standard treatments for stable ischemic heart disease (SIHD).
• The efficacy of PCI and CABG in reducing heart attacks and mortality in SIHD patients remains under scrutiny.
• Healthcare reimbursement is shifting from fee-for-service to value-based payments, increasing focus on procedure effectiveness.

Purpose of the Study:

• To examine the variability and appropriateness of PCI and CABG use in SIHD patients.
• To propose health policy interventions for managing the transition to value-based care in revascularization procedures.
• To highlight the need for improved quality in SIHD management.

Main Methods:

• Analysis of international and domestic data on PCI and CABG utilization in SIHD.
• Review of quality improvement trends over the past five years.
• Identification of potential health policy interventions.

Main Results:

• Significant variability exists in PCI and CABG use across different healthcare settings.
• While some quality improvements have been observed, inappropriate procedures persist.
• Approximately 25% of hospitals perform unnecessary PCI in SIHD patients at a rate nearing 25%.

Conclusions:

• The current status of revascularization for SIHD, despite some improvements, is unacceptable.
• Health policy interventions, including registry enhancements, updated criteria, shared decision-making, and evidence-based management, are crucial.
• Optimizing PCI and CABG use in SIHD can serve as a model for broader healthcare quality improvement initiatives.