Author + information
- Jasmine Patel1,
- Edmund Lau2,
- Steve Kurtz3,
- Michael Savage4,
- David Fischman5 and
- Nicholas Ruggiero II, M.D., FACP, FACC, FSCAI, FSVM, FCPP5
- 1Exponent, Philadelphia, Pennsylvania, United States
- 2Exponent, Menlo Park, California, Japan
- 3Exponent, Inc., Philadelphia, PA, Pennsylvania, United States
- 4Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
- 5The Angioplasty Center at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
Percutaneous coronary intervention (PCI) is one of the most widely used and costly procedures for the US health care system. The potential over-utilization of PCI and stents has accordingly emerged as an important issue. As the FAME Trial demonstrated, use of Fractional Flow Reserve (FFR) reduces the number of stents by eliminating unnecessary interventions on lesions that are not physiologically significant. The purpose of this proposed study was to determine the incidence of FFR in a nationally represented population from 2005-2013 and its relative usage to diagnostic cardiac catheterization and PCI.
The 5% Medicare data was used to determine the incidence of Medicare patients who underwent PCI stenting procedures, diagnostic cardiac catheterization, and FFR between 2005 to 2013, calculated as the number of procedures per 100,000 Medicare enrollees. The relative FFR utilization rates were calculated based on the number of patients undergoing FFR divided by the number of patients undergoing diagnostic catheterization each year.
The average incidence of FFR utilization was calculated to be 54 procedures per 100,000 Medicare enrollees. Although low, the incidence of FFR utilization rate increased from 18.9 in 2005 to 118 in 2013. Approximately, 55% of FFR procedures were conducted in men aged 65-74. Geographically, FFR procedures were conducted primarily in the South (38%) and Midwest (28%). The average incidence of catheterization and PCI were calculated to be 2,663 and 803 procedures per 100,000 Medicare enrollees. The relative incidence of FFR per catheterization increased from 1% in 2005 to 5.3% in 2013. The Pearson correlation coefficient r was calculated to be -0.95, indicating a negative correlation between the incidence of FFR and PCI in the Medicare population.
The results show that FFR use is minimal in a nationally represented population, although the rates of usage have been increasing. In addition, a negative correlation between PCI and FFR use was determined. Further analysis is required to determine FFR and PCI/stent utilization by hospitals to assess their potential over-utilization.
OTHER: Quality, Guidelines and Appropriateness Criteria