title: [A novel standard protocol of long-term follow-up shared with general practitioners after percutaneous coronary intervention: appropriateness and economic impact].
abstract: BACKGROUND
  Follow-up modalities for patients undergoing percutaneous coronary intervention (PCI) are not well defined and standard protocols have been not established. The purpose of this study was to assess: a) the frequency and patterns of cardiology visits, echocardiographic examinations and stress tests after PCI in clinical practice; b) the impact of a multidisciplinary protocol of long-term follow-up after PCI shared with general practitioners on the appropriateness and reduction in healthcare costs.
  
  
  METHODS
  A total of 780 patients who underwent PCI in 2010 in two Italian hospitals were analyzed. The number of cardiological examinations (total, routine and clinically driven) performed during 2 years of follow-up were recorded and stratified according to the patient's risk profile. The latter was defined according to the multidisciplinary protocol. In addition, a simulation of the spread between provided and necessary tests (according to the multidisciplinary protocol) was carried out.
  
  
  RESULTS
  The mean number of cardiological examinations per patient provided during follow-up was 5, of which 4.4 were routine tests in asymptomatic patients. Routine tests were performed more frequently in patients at low risk compared to those at higher risk. By applying the multidisciplinary protocol to the case mix and by merging clinical visit and stress test or echocardiographic examination, a reduction of 0.87 tests per patient/year would be expected. This reduction would result in a 39% decrease in follow-up examinations in this specific clinical setting.
  
  
  CONCLUSIONS
  This observational study demonstrates that unnecessary cardiological clinical and functional tests are often performed in long-term follow-up of patients submitted to PCI. The application of a standard protocol of follow-up shared with general practitioners may help avoiding unnecessary consultations, thus reducing healthcare costs.
authors.affiliation: Dipartimento Cardio-Toraco-Vascolare, A.O. Carlo Poma, Mantova.
authors.forename: Corrado
authors.initials: C
authors.lastname: Lettieri
authors.affiliation: Dipartimento Cardiotoracovascolare "A. De Gasperis", A.O. Ospedale Niguarda Ca' Granda, Milano.
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.affiliation: Dipartimento Cardio-Toraco-Vascolare, A.O. Carlo Poma, Mantova.
authors.forename: Renato
authors.initials: R
authors.lastname: Rosiello
authors.affiliation: Dipartimento Cardiotoracovascolare "A. De Gasperis", A.O. Ospedale Niguarda Ca' Granda, Milano.
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.affiliation: Dipartimento Emergenza-Urgenza, A.O. Carlo Poma, Mantova.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Parogni
authors.affiliation: Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: Azienda Sanitaria Locale di Brescia, Brescia.
authors.forename: Erminio
authors.initials: E
authors.lastname: Tabaglio
authors.affiliation: Azienda Sanitaria Locale di Brescia, Brescia.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zadra
authors.affiliation: Ufficio Qualità, A.O. Papa Giovanni XXIII, Bergamo.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Cattaneo
authors.affiliation: Dipartimento Cardiotoracovascolare "A. De Gasperis", A.O. Ospedale Niguarda Ca' Granda, Milano.
authors.forename: Francesco
authors.initials: F
authors.lastname: Soriano
authors.affiliation: Azienda Sanitaria Locale di Mantova, Mantova.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galavotti
authors.affiliation: Dipartimento Cardiotoracovascolare "A. De Gasperis", A.O. Ospedale Niguarda Ca' Granda, Milano.
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.affiliation: Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo.
authors.forename: Orazio
authors.initials: O
authors.lastname: Valsecchi
authors.affiliation: Dipartimento Cardio-Toraco-Vascolare, A.O. Carlo Poma, Mantova.
authors.forename: Roberto
authors.initials: R
authors.lastname: Zanini
authors.affiliation: Dipartimento Cardiovascolare, A.O. Papa Giovanni XXIII, Bergamo.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013997:Time Factors; D019564:Unnecessary Procedures