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Determinants of cardiac catheterization use in older Medicare patients with acute myocardial infarction.
- Source :
-
Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2010 Jan; Vol. 3 (1), pp. 54-62. Date of Electronic Publication: 2009 Dec 08. - Publication Year :
- 2010
-
Abstract
- Background: Cardiac catheterization is substantially underused among higher-risk patients with acute myocardial infarction (AMI) with appropriate indications but overused among patients with inappropriate indications. We sought to determine the importance of anticipated benefit and anticipated harm on the use of cardiac catheterization among older patients with AMI.<br />Methods and Results: We performed an analysis of Medicare fee-for-service beneficiaries hospitalized with an AMI between 1998 and 2001. Multivariate models were developed to determine relative importance of anticipated benefit (baseline cardiovascular risk), anticipated harm (bleeding risk, comorbidities), and demographic factors (age, sex, race, regional invasive intensity) in predicting cardiac catheterization use within 60 days of AMI admission. Analyses were stratified by American College of Cardiology/American Heart Association class I or II as appropriate, and class III as inappropriate. Determinants of reduced likelihood of cardiac catheterization among 42 241 AMI patients with appropriate indications included (in order of importance) older age (likelihood chi(2)=1309.5), higher bleeding risk score (likelihood chi(2)=471.2), more comorbidities (likelihood chi(2)=276.6), female sex (likelihood chi(2)=162.9), hospitalization in low (likelihood chi(2)=67.9) or intermediate intensity invasive regions (likelihood chi(2)=22.4) (all P<0.001), and baseline cardiovascular risk (likelihood chi(2)=6.4, P=0.01). Among 2398 AMI patients with inappropriate indications, significant determinants of greater procedure likelihood included younger age, male sex, lower bleeding risk score, and fewer comorbidities.<br />Conclusions: Regardless of the procedure indication, the decision to perform cardiac catheterization in this population appears largely driven by demographic factors and potential harm rather than potential benefit of the procedure.
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Cardiac Catheterization adverse effects
Chi-Square Distribution
Comorbidity
Female
Hemorrhage etiology
Hospitalization statistics & numerical data
Humans
Likelihood Functions
Logistic Models
Male
Myocardial Infarction complications
Myocardial Infarction diagnosis
Risk Assessment
Risk Factors
Severity of Illness Index
Sex Factors
Time Factors
Treatment Outcome
United States
Cardiac Catheterization statistics & numerical data
Medicare statistics & numerical data
Myocardial Infarction therapy
Patient Selection
Practice Patterns, Physicians' statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7705
- Volume :
- 3
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular quality and outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 20123672
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.109.858456