Document Detail


Stress imaging use and repeat revascularization among medicare patients with high-risk coronary artery disease.
MedLine Citation:
PMID:  22819426     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The optimal use of stress testing after coronary revascularization remains unclear, and overuse of stress testing might increase the rates of repeat revascularization. We analyzed the association at both the patient and regional level between the use of stress testing and repeat revascularization for a cohort of Medicare beneficiaries receiving revascularization within 30 days of an admission for symptomatic coronary artery disease. The sample consisted of 219,748 Medicare beneficiaries aged >65 years who received percutaneous coronary intervention or cardiac bypass artery grafting after hospital admission for symptomatic coronary artery disease in 2003 to 2004. Medicare claims data through 2008 identified the use of stress testing and repeat revascularization. The associations between the cumulative incidence of stress testing and repeat revascularization were analyzed using linear regression analysis. Within 6 years of the initial revascularization, the cumulative incidence of events was 0.61 for stress testing and 0.23 for repeat revascularization. Most (53.1%) repeat revascularizations were preceded by a stress test. Only 10.3% of repeat revascularization procedures were preceded by myocardial infarction. The 4-year cumulative incidence of repeat revascularization and stress testing varied between the Hospital Referral Regions represented by the sample, and the positive correlation between the rates by the health referral region accounted for only a small portion of the total health referral region variation in revascularization rates. In conclusion, stress testing is commonly performed among Medicare patients after the initial revascularization, and most repeat procedures are performed for stable coronary artery disease. The variation in stress testing patterns only explained a modest fraction of the regional variation in the repeat revascularization rates.
Authors:
Joseph S Rossi; Jerome J Federspiel; Daniel J Crespin; Timothy S Carey; Brett C Sheridan; Sally C Stearns
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.     Date:  2012-07-21
Journal Detail:
Title:  The American journal of cardiology     Volume:  110     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-12     Completed Date:  2013-04-15     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1270-4     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. joe771@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Aged, 80 and over
Angioplasty, Balloon, Coronary / adverse effects,  methods*
Cohort Studies
Coronary Angiography / methods
Coronary Artery Bypass / adverse effects,  methods*
Coronary Artery Disease / mortality,  radiography,  therapy*
Coronary Restenosis / diagnosis,  epidemiology*,  therapy*
Databases, Factual
Echocardiography, Stress / methods,  statistics & numerical data
Exercise Test / methods,  statistics & numerical data*
Female
Follow-Up Studies
Hospital Mortality / trends
Humans
Incidence
Linear Models
Male
Medicare / statistics & numerical data
Monitoring, Physiologic / methods
Myocardial Revascularization / adverse effects,  methods
Retreatment / statistics & numerical data
Risk Assessment
Severity of Illness Index
Survival Analysis
United States
Grant Support
ID/Acronym/Agency:
F30 HL110483/HL/NHLBI NIH HHS; F30 HL110483/HL/NHLBI NIH HHS; R01 AG025801/AG/NIA NIH HHS; R01 AG025801/AG/NIA NIH HHS; T32 GM008719/GM/NIGMS NIH HHS; T32 HS000032/HS/AHRQ HHS
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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