Changes in geographic variation in the use of percutaneous coronary intervention for stable ischemic heart disease after publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial

Circulation. Cardiovascular Quality and Outcomes
Arun V MohanDavid H Howard

Abstract

Clinical uncertainty is cited as a cause of geographic variation. However, little is known about the effect of comparative effectiveness research on variation. We examined whether geographic variation in the use of percutaneous coronary intervention (PCI) for stable ischemic heart disease (SIHD) declined after publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. We examined changes in utilization and geographic variation in 67 hospital referral regions using the State Inpatient Databases. We compared age- and sex-adjusted rates of PCI for SIHD before (2006) and after (2008) publication of the COURAGE trial and compared those with contemporaneous changes in PCI volume for acute coronary syndrome. A total of 272,659 PCIs for SIHD from 526 hospitals were included in the analysis. After the publication of the COURAGE trial, PCI volume for SIHD declined by 25% (P<0.001) and decreased by 12% for acute coronary syndrome (P<0.001). This was predominantly attributable to changes in hospital referral regions with the highest levels of utilization pre-COURAGE trial (35% decline in the highest tertile versus 18% in the lowest). As measured by the systematic component of variation,...Continue Reading

References

Mar 4, 1993·The New England Journal of Medicine·W P WelchJ E Wennberg
Feb 24, 1999·JAMA : the Journal of the American Medical Association·G T O'ConnorJ E Wennberg
Sep 22, 1999·Journal of General Internal Medicine·L A PetersenJ Daley
Oct 26, 2002·BMJ : British Medical Journal·John E Wennberg
Apr 22, 2003·Health Affairs·John E WennbergJonathan S Skinner
Jun 9, 2005·Archives of Pediatrics & Adolescent Medicine·Teresa ToJacob C Langer
Mar 16, 2006·Journal of the National Cancer Institute·Sharon H GiordanoJames S Goodwin
Oct 3, 2006·Journal of the American College of Cardiology·Anthony A BavryArman T Askari
Mar 28, 2007·The New England Journal of Medicine·William E BodenUNKNOWN COURAGE Trial Research Group
Mar 28, 2007·The New England Journal of Medicine·Judith S Hochman, P Gabriel Steg
Jun 19, 2008·JAMA : the Journal of the American Medical Association·Ezekiel J Emanuel, Victor R Fuchs
Aug 16, 2008·The New England Journal of Medicine·Eric D Peterson, John S Rumsfeld
Nov 4, 2008·The Journal of Bone and Joint Surgery. American Volume·Gillian HawkerPaul Dieppe
Mar 14, 2009·Journal of the American College of Cardiology·Anthony N Demaria
May 22, 2009·The New England Journal of Medicine·Shamir R MehtaUNKNOWN TIMACS Investigators
Oct 13, 2009·Medical Care·Barry G SaverLaura-Mae Baldwin
Feb 16, 2011·Annals of Internal Medicine·Amy S KelleyCatherine A Sarkisian
Mar 17, 2011·JAMA : the Journal of the American Medical Association·H Gilbert WelchJohn E Wennberg
Apr 21, 2011·Circulation. Cardiovascular Quality and Outcomes·Bina AhmedUNKNOWN Northern New England Cardiovascular Disease Study
May 5, 2011·JAMA : the Journal of the American Medical Association·Andrew J EpsteinPeter W Groeneveld
May 12, 2011·JAMA : the Journal of the American Medical Association·William B BordenJohn A Spertus
May 19, 2011·Circulation. Cardiovascular Quality and Outcomes·Edward J McNulty
May 21, 2011·The Journal of Economic Perspectives : a Journal of the American Economic Association·Amitabh ChandraJonathan S Skinner
Mar 7, 2012·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Pamela R SoulosCary P Gross
Aug 29, 2012·The New England Journal of Medicine·Bernard De BruyneUNKNOWN FAME 2 Trial Investigators

❮ Previous
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Citations

Mar 12, 2016·The Journal of Thoracic and Cardiovascular Surgery·Luke K KimDmitriy N Feldman
Jul 2, 2014·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Nicole E WordenRobert M Weiss
Feb 7, 2017·PloS One·Julián LibreroUNKNOWN Spanish Atlas of Medical Practice Variation Research Group
Aug 26, 2017·European Heart Journal. Quality of Care & Clinical Outcomes·Marjan VaezTorbjörn Ivert
Aug 15, 2015·Cardiology in Review·Purav ModyWilliam E Boden
Dec 14, 2019·Journal of Cardiovascular Translational Research·Baofu WangMingjing Zhao
Feb 12, 2021·Health Services Research·Alexander EverhartPinar Karaca-Mandic

❮ Previous
Next ❯

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