Journal article
Variability in utilization of drug eluting stents in United States: Insights from nationwide inpatient sample
Catheterization and cardiovascular interventions, Vol.87(1), pp.23-33
01/01/2016
DOI: 10.1002/ccd.25977
PMID: 26032938
Abstract
Objectives: We studied the trends and predictors of drug eluting stent (DES) utilization from 2006 to 2011 to further expound the inter-hospital variability in their utilization.
Background: We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) between 2006 and 2011 using ICD-9-CM procedure code, 36.06 (bare metal stent) or 36.07 (drug eluting stents) for Percutaneous Coronary Intervention (PCI). Annual hospital volume was calculated using unique identification numbers and divided into quartiles for analysis.
Methods and results: We built a hierarchical two level model adjusted for multiple confounding factors, with hospital ID incorporated as random effects in the model. About 665,804 procedures (weighted n = 3,277,884) were analyzed. Safety concerns arising in 2006 reduced utilization DES from 90% of all PCIs performed in 2006 to a nadir of 69% in 2008 followed by increase (76% of all stents in 2009) and plateau (75% in 2011). Significant between-hospital variation was noted in DES utilization irrespective of patient or hospital characteristics. Independent patient level predictors of DES were (OR, 95% CI, P-value) age (0.99, 0.98-0.99, <0.001), female(1.12, 1.09-1.15, <0.001), acute myocardial infarction(0.75, 0.71-0.79, <0.001), shock (0.53, 0.49-0.58, <0.001), Charlson Co-morbidity index (0.81,0.77-0.86, <0.001), private insurance/HMO (1.27, 1.20-1.34, <0.001), and elective admission (1.16, 1.05-1.29, <0.001). Highest quartile hospital (1.64, 1.25-2.16, <0.001) volume was associated with higher DES placement.
Conclusion: There is significant between-hospital variation in DES utilization and a higher annual hospital volume is associated with higher utilization rate of DES.
Details
- Title: Subtitle
- Variability in utilization of drug eluting stents in United States: Insights from nationwide inpatient sample
- Creators
- Sidakpal S Panaich - Detroit Medical Center, Michigan, DetroitApurva O Badheka - Department of Cardiology, Yale School of Medicine, Connecticut, New HavenShilpkumar Arora - Department of Internal Medicine, Mount Sinai St. Luke's Roosevelt Hospital, New York, New YorkNileshkumar J Patel - Department of Internal Medicine, Staten Island University Hospital, New York, Staten IslandBadal Thakkar - Department of Internal Medicine, Tulane School of Public Health & Tropical Medicine, Louisiana, New OrleansNilay Patel - Department of Internal Medicine, Saint Peter's University Hospital, New Jersey, New BrunswickVikas Singh - Department of Cardiology, University of Miami Miller School of Medicine, Florida, MiamiAnkit Chothani - Department of Internal Medicine, MedStar Washington Hospital Center, District of Columbia, WashingtonAbhishek Deshmukh - Department of Cardiology, Mayo Clinic, Minnesota, RochesterKanishk Agnihotri - Department of Internal Medicine, Saint Peter's University Hospital, New Jersey, New BrunswickSunny Jhamnani - Department of Cardiology, Yale School of Medicine, Connecticut, New HavenSopan Lahewala - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New YorkSohilkumar Manvar - Detroit Medical Center, Michigan, DetroitVinaykumar Panchal - Department of Internal Medicine, Tulane School of Public Health & Tropical Medicine, Louisiana, New OrleansAchint Patel - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New YorkNeil Patel - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New YorkParth Bhatt - Department of Internal Medicine, Tulane School of Public Health & Tropical Medicine, Louisiana, New OrleansChirag Savani - Department of Internal Medicine, New York Medical College, New York, ValhallaJay Patel - Detroit Medical Center, Michigan, DetroitGhanshyambhai T Savani - Department of Internal Medicine, Prince George's Hospital Center, Maryland, CheverlyShantanu Solanki - Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New YorkSamir Patel - Department of Internal Medicine, Western Reserve Health System, Ohio, YoungstownAmir Kaki - Detroit Medical Center, Michigan, DetroitTamam Mohamad - Detroit Medical Center, Michigan, DetroitMahir Elder - Detroit Medical Center, Michigan, DetroitAshok Kondur - Detroit Medical Center, Michigan, DetroitMichael Cleman - Department of Cardiology, Yale School of Medicine, Connecticut, New HavenJohn K Forrest - Department of Cardiology, Yale School of Medicine, Connecticut, New HavenTheodore Schreiber - Detroit Medical Center, Michigan, DetroitCindy Grines - Detroit Medical Center, Michigan, Detroit
- Resource Type
- Journal article
- Publication Details
- Catheterization and cardiovascular interventions, Vol.87(1), pp.23-33
- Publisher
- Blackwell Publishing Ltd
- DOI
- 10.1002/ccd.25977
- PMID
- 26032938
- ISSN
- 1522-1946
- eISSN
- 1522-726X
- Number of pages
- 11
- Language
- English
- Date published
- 01/01/2016
- Academic Unit
- Cardiovascular Medicine; Internal Medicine
- Record Identifier
- 9984094568402771
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