Appropriateness of coronary artery bypass graft surgery performed in northern New England.
OBJECTIVE
The goal of this study was to assess the concordance between the American College of Cardiology (ACC) and the American Heart Association (AHA) 2004 Guideline Update for Coronary Artery Bypass Graft Surgery and actual clinical practice.


BACKGROUND
There is substantial geographic variability in the population-based rates of coronary artery bypass graft (CABG) procedures, and in recent years, there have been several public concerns about unnecessary cardiac care. The actual rate of inappropriate cardiac procedures is unknown.


METHODS
We evaluated 4,684 consecutive isolated coronary artery bypass graft procedures performed in 2004 and 2005 in northern New England. Our regional registry data were used to categorize patients into clinical subgroups. Detailed clinical criteria were then used to categorize procedures within these subgroups as class I (useful and effective), class IIa (evidence favors usefulness), class IIb (evidence less well established), and class III (not useful or effective).


RESULTS
Among these 4,684 procedures, we were able to classify 99.6% (n = 4,665). The majority of procedures were class I (87.7%). Class II procedures totaled 10.9%. The remaining 1.4% of procedures were class III.


CONCLUSIONS
In this regional study, we found that 98.6% of CABG procedures that could be classified were considered to be appropriate. In these data, actual clinical practice closely follows the recommendations of the 2004 ACC/AHA guidelines for CABG surgery.
O'Connor
Gerald T
GT
Department of Medicine and of Community and Family Medicine, and Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire 03756, USA. gerald.t.oconnor@dartmouth.edu
Olmstead
Elaine M
EM
Nugent
William C
WC
Leavitt
Bruce J
BJ
Clough
Robert A
RA
Weldner
Paul W
PW
Charlesworth
David C
DC
Chaisson
Kristine
K
Sisto
Donato
D
Nowicki
Edward R
ER
Cochran
Richard P
RP
Malenka
David J
DJ
D000572:American Heart Association; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009511:New England; D017410:Practice Guidelines as Topic; D012042:Registries; D013318:Stroke Volume; D014481:United States