Abstract 20506: Use of Physiological Assessment With Prior Stress Testing and Fractional Flow Reserve in Elderly Patients Undergoing Elective Percutaneous Coronary Intervention
Introduction: Current Appropriate Use Criteria (AUC) and guidelines for coronary revascularization emphasize the value of non-invasive stress testing and/or fractional flow reserve (FFR) prior to elective PCI. The objective of this study was to examine contemporary use of stress testing and FFR in Medicare patients undergoing elective PCI, and whether FFR was more frequently used in patients without prior stress testing.
Methods: We performed a retrospective, observational cohort study using a 20% sample of 2012-2013 Medicare beneficiaries aged 65 to 99 years old who were fee-for-service eligible. The percentage of patients with stress testing within 90 days prior to PCI and FFR at the time of elective PCI was calculated after excluding those with recent AMI, hospital emergency room visits, PCI, and CABG. We created multivariable models exploring the likelihood of undergoing FFR with or without prior stress testing.
Results: A total of 39,946 elective PCIs between 2012 and 2013 were identified, with mean age 76.5, 36.5% women and 5.3% black. 20,415 (51.1%) underwent stress testing within 90 days of their elective PCI and 2856 (7.1%) underwent FFR, while 18,073 (45.2%) underwent neither stress testing nor FFR. Patients without prior stress testing were more likely to undergo FFR compared to those with stress testing (OR, 1.10; 95% CI, 1.02-1.18), but FFR use was low in both groups (7.5% versus 6.8% respectively).
Conclusion: We found low utilization of both stress testing and FFR prior to elective PCI in Medicare beneficiaries, suggesting the need for further quality assurance programs to improve physiologic assessment in this cohort.
Author Disclosures: T.A. Joseph: None. J. Lehrich: None. P.S. Chan: None. J.P. Curtis: Employment; Significant; American College of Cardiology, Centers for Medicare & Medicaid Services. Ownership Interest; Significant; Equity holding in Medtronic. N.R. Desai: Employment; Significant; Works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures. Other Research Support; Significant; Receives support from Johnson & Johnson to develop methods of clinical trial data sharing and from the Blue Cross Blue Shield Association (BCBSA) to better understand technology evidence generation. V.L. Murthy: Ownership Interest; Significant; Own stock in General Electric. N. Curzen: Research Grant; Significant; unrestricted grants from Boston Scientific, Medtronic, HeartFlow, Haemonetics, St Jude Medical. Speakers Bureau; Significant; HeartFlow, Haemonetics, St Jude Medical. Consultant/Advisory Board; Significant; HeartFlow, Haemonetics, St Jude Medical. B.K. Nallamothu: Honoraria; Significant; Received honorarium from the American College of Cardiology and American Heart Association for editorial work on their online websites and journals.
- © 2016 by American Heart Association, Inc.