Abstract 19960: Variation of Utilization of Intravascular Ultrasound and Fractional Flow Reserve in the United States: Influence of Hospital Volume
Background: There is limited data regarding utilization of Intravascular Ultrasound (IVUS) and Fractional Flow Reserve (FFR).
Objective: The purpose of this study was to investigate inter-hospital variation of utilization of IVUS and FFR.
Methods: We queried Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample(NIS) between 2008 -2011 using the ICD-9-CM procedure code 36.06 (bare metal stent), 36.07(drug eluting stent). We used procedural code 00.24 for IVUS and 00.59 for FFR. All procedures performed in patients >=18 years were included. Annual hospital volume was calculated using unique identification numbers and then divided into quartiles for analysis. NIS is the largest all payor dataset which represents 20% of all hospitals in the US. We built a hierarchical two level model adjusted for multiple confounding factors. Inter class correlation (ICC) was calculated for variation measure from hierarchical model.
Results: Total 403759 (weighted - 1,989,345) procedures were identified. Multivariate regression analysis showed that advanced age, Charlson’s Comorbidity Index (CCI) >=2, AMI, emergent/urgent status were predictors of lower IVUS utilization. Increasing age, AMI, and shock were associated with lower utilization of FFR. Higher IVUS utilization (OR, 95% CI, P-Value), (1.30, 1.02-1.66, 0.034) was noted in highest hospital volume quartile as compared to lowest hospital volume quartile. Lower FFR utilization (0.26, 0.17-0.39, <0.001) was seen in highest hospital volume quartiles as compared to lowest hospital volume quartile, (Fig.1). We observed approximately ~43% and ~40% between-hospital variations in rates of IVUS and FFR utilization respectively as depicted by the ICCs.
Conclusion: The utilization rate of IVUS and FFR varied considerably amongst hospitals. Higher hospital volume is associated with higher utilization rate of IVUS and lower utilization of FFR.
Author Disclosures: N. Patel: None. S. Arora: None. N.J. Patel: None. N. Patel: None. A. Patel: None. S. Lahewala: None. S. Solanki: None. G. Dhaduk: None. G.T. Savani: None. K. Gada: None. A. Deshmukh: None. A.O. Badheka: None. N.K. Mittal: None. T. Mohamad: None. M. Brown: None. U. Gidwani: None. C. Grines: None. T. Schreiber: None.
- © 2014 by American Heart Association, Inc.