TY - JOUR

T1 - Guidelines versus reality

T2 - is coronary stent application in three-vessel disease standard or the exception?

AU - Linder, Roland

AU - Zeidler, J.

AU - Verheyen, F.

AU - von der Schulenburg, J. M.Graf

AU - Haverich, A.

AU - Schilling, T.

N1 - Publisher Copyright: © 2017, Springer-Verlag GmbH Germany. Copyright: Copyright 2018 Elsevier B.V., All rights reserved.

PY - 2018/7

Y1 - 2018/7

N2 - The national guidelines for treatment of chronic coronary heart disease (CHD) recommend surgical coronary aortic bypass grafting (CABG) rather than percutaneous coronary intervention (PCI) for patients with a coronary three-vessel disease. The epidemiology of three-vessel CHD and data about the application of different revascularisation strategies raise suspicion of deviation from the guidelines in the treatment of those patients. Claims data containing records of almost 10 million patients of the largest German statutory health insurance fund (Techniker Krankenkasse) were utilised to measure adherence to the guidelines for treatment of groups of patients with one-, two-, and three-vessel CHD, respectively. The impact of age, sex, and comorbidity on each patient’s revascularisation procedure was investigated as well. There was no significant difference in the rate of PCI between the groups. In conclusion, the hypothesis that patients with a coronary three-vessel disease are not always treated according to the recommendations of the national guidelines could not be disproved by this study. Finally, the results of this study suggest that the best revascularisation strategy for each patient with two- and three-vessel disease should be decided upon by an interdisciplinary discussion between both cardiologists and cardiac surgeons.

AB - The national guidelines for treatment of chronic coronary heart disease (CHD) recommend surgical coronary aortic bypass grafting (CABG) rather than percutaneous coronary intervention (PCI) for patients with a coronary three-vessel disease. The epidemiology of three-vessel CHD and data about the application of different revascularisation strategies raise suspicion of deviation from the guidelines in the treatment of those patients. Claims data containing records of almost 10 million patients of the largest German statutory health insurance fund (Techniker Krankenkasse) were utilised to measure adherence to the guidelines for treatment of groups of patients with one-, two-, and three-vessel CHD, respectively. The impact of age, sex, and comorbidity on each patient’s revascularisation procedure was investigated as well. There was no significant difference in the rate of PCI between the groups. In conclusion, the hypothesis that patients with a coronary three-vessel disease are not always treated according to the recommendations of the national guidelines could not be disproved by this study. Finally, the results of this study suggest that the best revascularisation strategy for each patient with two- and three-vessel disease should be decided upon by an interdisciplinary discussion between both cardiologists and cardiac surgeons.

KW - Chronic coronary heart disease

KW - Claims data

KW - Coronary aortic bypass grafting

KW - Health services research

KW - Percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=85027839605&partnerID=8YFLogxK

U2 - 10.1007/s10198-017-0924-4

DO - 10.1007/s10198-017-0924-4

M3 - Article

C2 - 28823011

AN - SCOPUS:85027839605

VL - 19

SP - 821

EP - 830

JO - European Journal of Health Economics

JF - European Journal of Health Economics

SN - 1618-7598

IS - 6

ER -