| Evaluating the effectiveness of a rapidly adopted cardiovascular technology with administrative data: the case of drug-eluting stents for acute coronary syndromes. | |
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MedLine Citation:
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PMID: 22877806 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Instrumental variable (IV) methods can correct for unmeasured confounding when using administrative (claims) data for cardiovascular outcomes research, but difficulties identifying valid IVs have limited their use. We evaluated the safety and efficacy of drug-eluting coronary stents (DES) compared with bare-metal stents (BMS) for Medicare beneficiaries with acute coronary syndromes using the rapid uptake of DES in clinical practice as an instrument. We compared results from IV with those from propensity score matching (PSM) and multivariable regression models. METHODS: This is a retrospective cohort study involving 62,309 fee-for-service beneficiaries 66 years and older treated with coronary stenting between May 2003 and February 2004. Outcomes were measured for 46 months after revascularization using claims data. RESULTS: Recipients of DES were younger, had a lower prevalence of myocardial infarction, and had fewer comorbidities compared with BMS recipients. Use of DES was associated with lower rates of mortality by PSM (hazard ratio [HR] 0.80, CI 0.77-0.83) but not by IV (HR 0.99, CI 0.87-1.11). Instrumental variable models estimated a larger reduction in repeat revascularization (HR 0.76, CI 0.63-0.89) than did PSM (HR 0.90, CI 0.87-0.93). CONCLUSIONS: Based on IV analysis, the increased utilization of DES relative to BMS among Medicare beneficiaries with acute coronary syndrome is associated with reduced rates of repeat revascularization and no difference in mortality. Instrumental variable approaches provide a useful complement to conventional approaches to cardiovascular outcomes research with administrative data. |
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Authors:
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Jerome J Federspiel; Sally C Stearns; Brett C Sheridan; Jack J Kuritzky; Laura P D'Arcy; Daniel J Crespin; Timothy S Carey; Joseph S Rossi |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: American heart journal Volume: 164 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2012 Aug |
Date Detail:
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Created Date: 2012-08-10 Completed Date: 2012-10-10 Revised Date: 2013-01-15 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 207-14 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2012 Mosby, Inc. All rights reserved. |
Affiliation:
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Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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therapy* Aged Aged, 80 and over Cohort Studies Drug-Eluting Stents / statistics & numerical data* Female Humans Logistic Models Male Multivariate Analysis Propensity Score Prosthesis Implantation Retrospective Studies Stents / statistics & numerical data Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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F30 HL110483/HL/NHLBI NIH HHS; R01 AG025801/AG/NIA NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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