Featured Research

from universities, journals, and other organizations

Not all U.S. hospitals are following guidelines for percutaneous revascularization procedures for some patients with an occluded artery following a heart attack

Date:
July 12, 2011
Source:
JAMA and Archives Journals
Summary:
Guideline recommendations for the appropriate use of percutaneous coronary intervention (PCI) for patients who have an occluded coronary artery after having a myocardial infarction (heart attack) appear not to have been fully incorporated in clinical practice, according to a new study.

Guideline recommendations for the appropriate use of percutaneous coronary intervention (PCI) for patients who have an occluded coronary artery after having a myocardial infarction (heart attack) appear not to have been fully incorporated in clinical practice, according to a report published Online First by Archives of Internal Medicine, one of the JAMA/Archives journals. The article is part of the journal's Less Is More series.

In 2006, results from the National Heart, Lung, and Blood Institute -- sponsored Occluded Artery Trial (OAT) were published, according to background information in the article. The study examined the effect of PCI, such as using balloon angioplasty and stenting, on completely blocked arteries identified a minimum of 24 hours (on calendar days 3 to 28) after a myocardial infarction (MI) in stable patients. "The OAT results provided objective evidence that the use of PCI did not lead to a reduction in clinical events and that the beneficial effect on angina and quality of life was small and not durable," write the authors. "Percutaneous coronary intervention was more costly than optimal medical therapy alone; hence, these findings should have discouraged routine PCI in this setting." Accordingly, after the trial results were published, the American College of Cardiology and the American Heart Association updated their guidelines.

Marc W. Deyell, M.D., from the University of British Columbia in Vancouver, Canada, and colleagues sought to determine whether clinical practice had changed following the revised guidelines. They examined data from the CathPCI Registry, which collects information from U.S. hospitals that perform cardiac catheterization. The authors compared PCI rates before and after the OAT trial results were published and the guidelines updated, from 2005 to 2008. They studied trends in hospitals in the highest quartile for reporting diagnostic procedures, because institutions are not required to report diagnostic catheterization.

The study included data from 896 hospitals and 28,780 patient visits. Percutaneous coronary intervention was performed in 11,083 patients before the OAT results were published; 7,838 between publication and guideline changes; and 9,859 after guidelines were revised. After adjusting for other variables, the authors report no overall significant decrease in the monthly rate of PCI performed for blockages either after the OAT results were published or after guidelines were changed. Among hospitals that consistently reported procedures done for diagnostic purposes, PCI rates did not diminish after OAT publication, but did appear to trend downward with a small decrease after the guidelines were revised.

"In conclusion, among this large cross-section of hospitals in the United States we found only modest evidence that the results of the OAT and its incorporation into major guideline revisions have influenced cardiology and interventional cardiology practice over the subsequent 1 to 2 years," write the authors. "Percutaneous coronary intervention of total occlusions identified greater than 24 hours after MI remains commonplace despite little evidence to support its use in stable patients and new clinical practice guidelines recommending against it." The researchers point out that this means many patients may be receiving an expensive intervention that does not help them, and that the large amount of time and effort devoted to the research did not appear to have a sizable influence on U.S. clinical practice.

Commentary: The OAT Results, Guideline Revisions and Clinical Practice

Mauro Moscucci, M.D., M.B.A., from the University of Miami's Miller School of Medicine, wrote a commentary which accompanies the paper by Deyell and colleagues. Considering the apparent lack of overall change in PCI usage, he states, "The reason for the observed failure of reversal is multifactorial." Barriers to changing physicians' and patients' beliefs and behaviors may have played a part.

"The study by Deyell et al adds an important chapter to the evaluation of appropriate use of PCI and further focuses our attention on procedures that certainly increase health care expenditures without clear benefit," remarks Moscucci. "While the debate on health care reform is ongoing, health care expenditures in the United States are continuing to escalate. Thus, we must heed the call to professional responsibility aimed at the elimination of tests and treatments that do not result in any benefit for our patients, and for which the net effects will be added costs, waste, and possible harm."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. M. W. Deyell, C. E. Buller, L. H. Miller, T. Y. Wang, D. Dai, G. A. Lamas, V. S. Srinivas, J. S. Hochman. Impact of National Clinical Guideline Recommendations for Revascularization of Persistently Occluded Infarct-Related Arteries on Clinical Practice in the United States. Archives of Internal Medicine, 2011; DOI: 10.1001/archinternmed.2011.315
  2. M. Moscucci. Medical Reversal, Clinical Trials, and the "Late" Open Artery Hypothesis in Acute Myocardial Infarction. Archives of Internal Medicine, 2011; DOI: 10.1001/archinternmed.2011.299

Cite This Page:

JAMA and Archives Journals. "Not all U.S. hospitals are following guidelines for percutaneous revascularization procedures for some patients with an occluded artery following a heart attack." ScienceDaily. ScienceDaily, 12 July 2011. <www.sciencedaily.com/releases/2011/07/110712191811.htm>.
JAMA and Archives Journals. (2011, July 12). Not all U.S. hospitals are following guidelines for percutaneous revascularization procedures for some patients with an occluded artery following a heart attack. ScienceDaily. Retrieved July 25, 2014 from www.sciencedaily.com/releases/2011/07/110712191811.htm
JAMA and Archives Journals. "Not all U.S. hospitals are following guidelines for percutaneous revascularization procedures for some patients with an occluded artery following a heart attack." ScienceDaily. www.sciencedaily.com/releases/2011/07/110712191811.htm (accessed July 25, 2014).

Share This




More Health & Medicine News

Friday, July 25, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Beatings and Addiction: Pakistan Drug 'clinic' Tortures Patients

Beatings and Addiction: Pakistan Drug 'clinic' Tortures Patients

AFP (July 24, 2014) A so-called drugs rehab 'clinic' is closed down in Pakistan after police find scores of ‘patients’ chained up alleging serial abuse. Duration 03:05 Video provided by AFP
Powered by NewsLook.com
Too Few Teens Receiving HPV Vaccination, CDC Says

Too Few Teens Receiving HPV Vaccination, CDC Says

Newsy (July 24, 2014) The Centers for Disease Control and Prevention is blaming doctors for the low number of children being vaccinated for HPV. Video provided by Newsy
Powered by NewsLook.com
New Painkiller Designed To Discourage Abuse: Will It Work?

New Painkiller Designed To Discourage Abuse: Will It Work?

Newsy (July 24, 2014) The FDA approved Targiniq ER on Wednesday, a painkiller designed to keep users from abusing it. Like any new medication, however, it has doubters. Video provided by Newsy
Powered by NewsLook.com
Doctor At Forefront Of Fighting Ebola Outbreak Gets Ebola

Doctor At Forefront Of Fighting Ebola Outbreak Gets Ebola

Newsy (July 24, 2014) Sheik Umar Khan has treated many of the people infected in the Ebola outbreak, and now he's become one of them. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

More Coverage


Artery-Opening Procedure Still Widely Used in Spite of Changed Guidelines, Study Finds

July 11, 2011 Despite changes in standard treatment practice guidelines issued by the American College of Cardiology, American Heart Association and the European Society of Cardiology several years ago, there has ... read more
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins