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Coronary Revascularization Remains Common Despite Guidelines Recommending Optimal Medical Therapy


Coronary Revascularization Remains Common Despite Guidelines Recommending Optimal Medical Therapy


Despite treatment guidelines that favor optimal medical therapy, the number of patients hospitalized for coronary revascularization remains steady, according to a study conducted by Cardiac Data Solutions and presented at the recently completed American College of Cardiology 61st Scientific Sessions in Chicago. Approximately 25 million Americans are diagnosed with coronary heart disease (CHD), two million of whom are hospitalized each year. Half of those hospitalizations are for coronary revascularization.

The research, conducted from October 1, 2008 to September 30, 2010, studied procedure volume trends among all Medicare beneficiaries (MB) undergoing coronary revascularization, including coronary artery bypass graft (CABG) surgery and/or PCI in both acute care and outpatient settings in the United States.

During the study period, both isolated CABG admissions and inpatient PCI admissions declined at average rates of 2.7 percent and 4.8 percent, respectively, while the percentage of PCI performed on an outpatient basis increased by 26.5 percent. The study also looked at mortality rates at the time of discharge and found that the risk-adjusted rates for inpatient PCI increased annually, while outpatient PCI remained unchanged, and CABG mortality significantly decreased.

"We expect to see these volume trends continue, especially as healthcare reform creates incentives to reduce hospital admissions and provide more care in the non-acute care setting," stated April Simon, RN, MSN, one of the researchers and president of Cardiac Data Solutions. "As admission status changes, we would also hope for an increase in the use of optimal medical therapy in conjunction with revascularization procedures to help reduce mortality rates." 

Other researchers included: Aaron D. Kuglemass, MD, Baystate Health; Phillip P. Brown, MD, Cardiac Data Solutions; Matthew R. Reynolds, MD, Harvard Clinical Research Institute; David J. Cohen, MD, St. Luke's Mid-America Heart Institute; and Steven D. Culler, PhD, Rollins School of Public Health, Emory University.

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