title: Current use of fractional flow reserve: a nationwide survey.
abstract: Major medical society guidelines recommend the measurement of fractional flow reserve (FFR) as an aid in choosing percutaneous coronary intervention in patients with stable coronary artery disease. We investigated the measurement of FFR among interventionalists, analyzing operators' attributes and decision-making processes to reveal differences in their applications of FFR and the reasons for those differences. An electronic survey study of 1,089 interventionalists was performed from 2 February through 6 March 2012, yielding 255 responses. Most respondents were >45 years old (58%), worked primarily in a community hospital (59%), and performed 10 to 30 cases per month (52%). More than half (145/253, 57%) used FFR measurement in less than one third of cases, and 39 of 253 (15%) never used it. There were no differences in use of FFR by age, practice location, or angiogram volume (P >0.05 for all). Respondents used FFR measurement more frequently than intravascular ultrasonography (73% vs 60%) to help guide the decision to stent (P <0.01). Operators reported that their primary reasons for not using FFR were lack of availability (47%) and problems with reimbursement (39%). There was no difference in FFR use by operator age, practice setting, or case volume.
authors.forename: Bashar
authors.initials: B
authors.lastname: Hannawi
authors.forename: Wilson W
authors.initials: WW
authors.lastname: Lam
authors.forename: Suwei
authors.initials: S
authors.lastname: Wang
authors.forename: George A
authors.initials: GA
authors.lastname: Younis
mesh_terms: D000328:Adult; D006328:Cardiac Catheterization / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000191:economics / Q000503:physiopathology / Q000628:therapy; D003661:Decision Support Techniques; D053805:Fractional Flow Reserve, Myocardial; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends; D011237:Predictive Value of Tests; D011379:Prognosis; D012051:Reimbursement Mechanisms; D015607:Stents; D018084:Ultrasonography, Interventional; D014481:United States
keywords: Angioplasty, balloon, coronary/economics; blood flow velocity; cardiac catheterization/statistical & numerical data; cardiology/standards; coronary stenosis/therapy; fractional flow reserve, myocardial/physiology; myocardial revascularization/standards; quality-adjusted life years; questionnaires; stents/economics; task performance and analysis