Temporal Trends in Percutaneous Coronary Intervention Appropriateness: Insights from the Clinical Outcomes Assessment Program
Background—It is unknown if the appropriate use of PCI has improved over time and whether trends in PCI appropriateness have been accompanied by changes in the use of PCI.
Methods and Results—We applied Appropriate Use Criteria to determine the appropriateness of all 51,872 PCI performed in Washington State from 2010 through 2013. We evaluated the number of PCI performed from 2006 through 2013 to provide a comparator period that preceded statewide appropriateness assessment beginning in 2010. Between 2010 and 2013, the overall number of PCI decreased by 6.8% (13,267 PCI in 2010 to 12,193 in 2013) with a 43% decline in the number of PCI for elective indications (3,818 PCI in 2010 to 2,193 in 2013). The decline in use of elective PCI was significantly larger following the onset of statewide PCI appropriateness assessment in 2010 (P = 0.03). The proportion of elective PCI classified as appropriate increased from 26% in 2010 to 38% in 2013 while the proportion of inappropriate PCI decreased from 16% to 13% (P<0.001 for trends). Significant improvements in the proportion of inappropriate PCI were limited to the tertile of hospitals with the largest decline in PCI classified as inappropriate (25% in 2010 to 12% in 2013; P=0.03).
Conclusions—In Washington State, the use of PCI for elective indications has decreased over time with concurrent improvements in PCI appropriateness. However, improvements in PCI appropriateness were limited to a minority of hospitals. Understanding processes at these high-performing hospitals may inform efforts to improve PCI appropriateness.
- Received December 30, 2014.
- Revision received April 21, 2015.
- Accepted April 27, 2015.