Details
| Original language | English |
|---|---|
| Pages (from-to) | 821-830 |
| Number of pages | 10 |
| Journal | European Journal of Health Economics |
| Volume | 19 |
| Issue number | 6 |
| Early online date | 19 Aug 2017 |
| Publication status | Published - Jul 2018 |
Abstract
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.
Keywords
- Chronic coronary heart disease, Claims data, Coronary aortic bypass grafting, Health services research, Percutaneous coronary intervention
ASJC Scopus subject areas
- Economics, Econometrics and Finance(all)
- Economics, Econometrics and Finance (miscellaneous)
- Medicine(all)
- Health Policy
Sustainable Development Goals
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In: European Journal of Health Economics, Vol. 19, No. 6, 07.2018, p. 821-830.
Research output: Contribution to journal › Article › Research › peer review
}
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 -