Abstract 14498: Variability in Practice Patterns and Consistency With Published Guidelines for Aortic and Pulmonary Balloon Valvuloplasty: An Analysis of Data From the IMPACT Registry
Introduction: Potential measures of quality in practice are its variability and consistency with published guidelines. We sought to assess, for the first time, these measures in congenital cardiac catheterization for aortic (AV) and pulmonary valvuloplasty (PV) procedures using the IMPACT Registry.
Methods: All procedures for isolated AV and PV between 1/11 and 9/15 were obtained from the IMPACT Registry. Hierarchical regression modeling was used to assess center-level differences in intervention indications, adjusted for patient- and procedure-level factors. Further, for cases >30 days of age with “high resting gradient” as the indication, consistency with the 2011 AHA Scientific Statement (pre-intervention gradient ≥40 mmHg and, for AS, pre-intervention aortic insufficiency <4+) was assessed, again adjusted for patient and procedure-level factors.
Results: The cohort consisted of 1071 AV procedures from 60 centers and 2207 PV procedures from 75 centers. For AV, indication was “high resting gradient” in 82%, “LV dysfunction” in 11%, “symptoms” in 5%, and “abnormal stress test/EKG” in 2%. For PV, indication was “high resting gradient” in 82%, “RV dysfunction” in 9%, “right to left shunting” in 6%, and “symptoms” in 5%. There were no center-level differences in the adjusted distribution of indications for either procedure. 86% of AV (IQR 78-100% per center) and 66% of PV (IQR 50-82% per center) done for “gradient” were consistent with guidelines. For AV, there were significant adjusted differences in consistency based on geographic region, with equivalent consistency in the Northeast and South, both significantly more consistent than the Midwest and West (overall p=0.005). For PV, there were significant adjusted individual center differences in consistency [median rate ratio=1.42 (95% CI 1.2 - 1.6), p<0.001], with pre-intervention gradient <40 mmHg in >50% of cases at 22% of centers.
Conclusions: Overall, there is more consistency with published guidelines for the practice of AV than for PV. For AV, consistency varies significantly across geographic regions. For PV, consistency varies significantly between centers. This suggests that similar patients are treated differently based on center factors and may have implications for quality of care.
Author Disclosures: A.C. Glatz: Research Grant; Significant; Children’s Heart Foundation. Consultant/Advisory Board; Modest; Bristol-Myers Squibb, Inc.. M.L. O’Byrne: None. K.F. Kennedy: None. J.J. Rome: None.
- © 2016 by American Heart Association, Inc.