Document Detail


Patterns and predictors of stress testing modality after percutaneous coronary stenting: data from the NCDR(®).
MedLine Citation:
PMID:  23058063     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We evaluated temporal trends and geographic variation in choice of stress testing modality after percutaneous coronary intervention (PCI), as well as associations between modality and procedure use after testing.
BACKGROUND: Stress testing is frequently performed post-PCI, but the choices among available modalities (electrocardiography only, nuclear, or echocardiography; pharmacological or exercise stress) and consequences of such choices are not well characterized.
METHODS: CathPCI Registry(®) data were linked with identifiable Medicare claims to capture stress testing use between 60 and 365 days post-PCI and procedures within 90 days after testing. Testing rates and modality used were modeled on the basis of patient, procedure, and PCI facility factors, calendar quarter, and Census Divisions using Poisson and logistic regression. Post-test procedure use was assessed using Gray's test.
RESULTS: Among 284,971 patients, the overall stress testing rate after PCI was 53.1 per 100 person-years. Testing rates declined from 59.3 in quarter 1 (2006) to 47.1 in quarter 4 (2008), but the relative use of modalities changed little. Among exercise testing recipients, adjusted proportions receiving electrocardiography-only testing varied from 6.8% to 22.8% across Census Divisions; and among exercise testing recipients having an imaging test, the proportion receiving echocardiography (versus nuclear) varied from 9.4% to 34.1%. Post-test procedure use varied among modalities; exercise electrocardiography-only testing was associated with more subsequent stress testing (13.7% vs. 2.9%; p < 0.001), but less catheterization (7.4% vs. 14.1%; p < 0.001) than imaging-based tests.
CONCLUSIONS: Modest reductions in stress testing after PCI occurring between 2006 and 2008 cannot be ascribed to trends in use of any single modality. Additional research should assess whether this trend represents better patient selection for testing or administrative policies (e.g., restricted access for patients with legitimate testing needs). Geographic variation in utilization of stress modalities and differences in downstream procedure use among modalities suggest a need to identify optimal use of the different test modalities in individual patients.
Authors:
Jerome J Federspiel; Daniel W Mudrick; Bimal R Shah; Sally C Stearns; Frederick A Masoudi; Patricia A Cowper; Cynthia L Green; Pamela S Douglas
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  5     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-12     Completed Date:  2013-03-25     Revised Date:  2014-10-10    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  969-80     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Centers for Medicare and Medicaid Services (U.S.)
Chi-Square Distribution
Coronary Artery Disease / diagnosis,  therapy*
Echocardiography / trends
Electrocardiography / trends
Exercise Test / methods,  trends*,  utilization
Female
Heart Function Tests / methods,  trends*,  utilization
Humans
Logistic Models
Male
Medicare
Odds Ratio
Percutaneous Coronary Intervention / adverse effects,  instrumentation*
Physician's Practice Patterns / trends*
Predictive Value of Tests
Registries
Residence Characteristics
Stents*
Time Factors
Tomography, Emission-Computed / trends
Treatment Outcome
United States
Grant Support
ID/Acronym/Agency:
F30 HL110483/HL/NHLBI NIH HHS; F30-HL110483/HL/NHLBI NIH HHS; HHSA290-2005-0032-I-TO4-WA3//PHS HHS; R01 AG025801/AG/NIA NIH HHS; T32 GM008719/GM/NIGMS NIH HHS; T32-GM008719/GM/NIGMS NIH HHS
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