Patient and hospital characteristics associated with inappropriate percutaneous coronary interventions.
OBJECTIVE
This study sought to examine whether rates of inappropriate percutaneous coronary intervention (PCI) differ by demographic characteristics and insurance status.


BACKGROUND
Prior studies have found that blacks, women, and those who have public or no health insurance are less likely to undergo PCI. Whether this reflects potential overuse in whites, men, and privately insured patients, in addition to underuse in disadvantaged populations, is unknown.


METHODS
Within the National Cardiovascular Data Registry CathPCI Registry, we identified 221,254 nonacute PCIs performed between July 2009 and March 2011. The appropriateness of PCI was determined using the Appropriate Use Criteria for coronary revascularization. Multivariable hierarchical regression was used to evaluate the association between patient demographics and insurance status and inappropriate PCI, as defined by the Appropriate Use Criteria.


RESULTS
Of 211,254 nonacute PCIs, 25,749 (12.2%) were classified as inappropriate. After multivariable adjustment, men (adjusted odd ratio [OR]: 1.08 [95% CI: 1.05 to 1.11]; p < 0.001) and whites (adjusted OR: 1.09 [95% CI: 1.05 to 1.14]; p < 0.001) were more likely to undergo an inappropriate PCI in comparison with women and nonwhites. Compared with privately insured patients, those who had Medicare (adjusted OR: 0.85 [95% CI: 0.83 to 0.88]), other public insurance (adjusted OR: 0.78 [95% CI: 0.73 to 0.83]), and no insurance (adjusted OR: 0.56 [95% CI: 0.50 to 0.61]) were less likely to undergo an inappropriate PCI (p < 0.001). In addition, compared with urban hospitals, those admitted at rural hospitals were less likely to undergo inappropriate PCI, whereas those at suburban hospitals were more likely.


CONCLUSIONS
For nonacute indications, PCIs categorized as inappropriate were more commonly performed in men, whites, and those who had private insurance. Higher rates of PCI in these patient populations may, in part, be due to procedural overuse.
Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri. Electronic address: pchan@cc-pc.com.
Paul S
PS
Chan
Duke Clinical Research Institute, Durham, North Carolina.
Sunil V
SV
Rao
VA Boston Healthcare System, Boston, Massachusetts; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Deepak L
DL
Bhatt
Denver VA Medical Center, Denver, Colorado.
John S
JS
Rumsfeld
University of Michigan, Ann Arbor, Michigan.
Hitinder S
HS
Gurm
University of Michigan, Ann Arbor, Michigan; VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Healthcare Outcomes and Policy, Ann Arbor, Michigan.
Brahmajee K
BK
Nallamothu
Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Matthew A
MA
Cavender
Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
Kevin F
KF
Kennedy
Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
John A
JA
Spertus
D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D012042:Registries; D012737:Sex Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American
CI; OR; PCI; confidence interval; disparities; odds ratio; overuse; percutaneous coronary intervention; quality of care