TY - JOUR
T1 - Variations in Practice Patterns and Consistency With Published Guidelines for Balloon Aortic and Pulmonary Valvuloplasty
T2 - An Analysis of Data From the IMPACT Registry
AU - Glatz, Andrew C.
AU - Kennedy, Kevin F.
AU - Rome, Jonathan J.
AU - O'Byrne, Michael L.
N1 - Funding Information:
The analysis in this manuscript was funded by the American College of Cardiology and National Cardiovascular Data Registry. The proposed project and manuscript were reviewed by the IMPACT Research and Publications Committee. The funding agencies had no role in the drafting of the manuscript or influencing its content. Dr. O’Byrne has received research support from the National Institute of Health/National Heart, Lung, and Blood Institute (K23 HL130420-01). Dr. Glatz has received research support from the Children’s Heart Foundation, the CHD Coalition, and Big Hearts to Little Hearts. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2018 American College of Cardiology Foundation
PY - 2018/3/26
Y1 - 2018/3/26
N2 - Objectives: The authors sought to study variation in the practice of balloon aortic (BAV) and pulmonary valvuloplasty (BPV). Background: The IMPACT (IMProving Adult and Congenital Treatment) registry provides an opportunity to study practice variation in transcatheter interventions for congenital heart disease. Methods: The authors studied BAV and BPV in the IMPACT registry from January 1, 2011, to September 30, 2015, using hierarchical multivariable models to measure hospital-level variation in: 1) the distribution of indications for intervention; and 2) in cases with “high resting gradient” as the indication, consistency with published guidelines. Results: A total of 1,071 BAV cases at 60 hospitals and 2,207 BPV cases at 75 hospitals were included. The indication for BAV was high resting gradient in 82%, abnormal stress test or electrocardiogram (2%), left ventricular dysfunction (11%), and symptoms (5%). Indications for BPV were high resting gradient in 82%, right-left shunt (6%), right ventricular dysfunction (7%), and symptoms (5%). No association between hospital characteristics and distribution of indications was demonstrated. Among interventions performed for “high resting gradient,” there was significant adjusted hospital-level variation in the rates of cases performed consistently with guidelines. For BAV, significant differences were seen across census regions, with hospitals in the East and South more likely to practice consistently than those in the Midwest and West (p = 0.005). For BPV, no association was found between hospital factors and rates of consistent practice, but there was significant interhospital variation (median rate ratio: 1.4; 95% confidence interval: 1.2 to 1.6; p < 0.001). Conclusions: There is measurable hospital-level variation in the practice of BAV and BPV. Further research is necessary to determine whether this affects outcomes or resource use.
AB - Objectives: The authors sought to study variation in the practice of balloon aortic (BAV) and pulmonary valvuloplasty (BPV). Background: The IMPACT (IMProving Adult and Congenital Treatment) registry provides an opportunity to study practice variation in transcatheter interventions for congenital heart disease. Methods: The authors studied BAV and BPV in the IMPACT registry from January 1, 2011, to September 30, 2015, using hierarchical multivariable models to measure hospital-level variation in: 1) the distribution of indications for intervention; and 2) in cases with “high resting gradient” as the indication, consistency with published guidelines. Results: A total of 1,071 BAV cases at 60 hospitals and 2,207 BPV cases at 75 hospitals were included. The indication for BAV was high resting gradient in 82%, abnormal stress test or electrocardiogram (2%), left ventricular dysfunction (11%), and symptoms (5%). Indications for BPV were high resting gradient in 82%, right-left shunt (6%), right ventricular dysfunction (7%), and symptoms (5%). No association between hospital characteristics and distribution of indications was demonstrated. Among interventions performed for “high resting gradient,” there was significant adjusted hospital-level variation in the rates of cases performed consistently with guidelines. For BAV, significant differences were seen across census regions, with hospitals in the East and South more likely to practice consistently than those in the Midwest and West (p = 0.005). For BPV, no association was found between hospital factors and rates of consistent practice, but there was significant interhospital variation (median rate ratio: 1.4; 95% confidence interval: 1.2 to 1.6; p < 0.001). Conclusions: There is measurable hospital-level variation in the practice of BAV and BPV. Further research is necessary to determine whether this affects outcomes or resource use.
KW - cardiac catheterization
KW - congenital heart disease
KW - health services research
KW - outcomes research
UR - http://www.scopus.com/inward/record.url?scp=85045899702&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2018.01.253
DO - 10.1016/j.jcin.2018.01.253
M3 - Article
C2 - 29566797
AN - SCOPUS:85045899702
SN - 1936-8798
VL - 11
SP - 529
EP - 538
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 6
ER -