Linksherzkatheteruntersuchungen und ihre invasive Konsequenz – Regionalvergleiche ermitteln auffällige Unterschiede

Abstract

The analysis indicates that there are specific regions in Saxony-Anhalt and diagnoses where the indications for LHC should be more conservative. However, more detailed analyses are needed to verify the identified potentials for improving healthcare provision.

Identifying and Investigating Ambulatory Care Sequences Before Invasive Coronary Angiography

“…CA allows the visualization of the coronary vasculature and is used in patients with known or suspected CAD, usually in connection with and as a basis for decision-making for revascularization therapy, namely coronary artery bypass graft or percutaneous coronary intervention (PCI) 13,14. This patient group is of particular interest: In Germany, CA rates have increased in recent decades,15,16 are strikingly high when compared with other countries,17–21 and show considerable unexplained regional variation 16,22. This has led to an ongoing discussion as to whether these rates reflect the actual need for CA or whether CA is performed too frequently in patients with stable CAD as a standard diagnostic procedure, or before conservative medical therapy options are exhausted 16,17,22,23.…”

“…13,14 This patient group is of particular interest: In Germany, CA rates have increased in recent decades, 15,16 are strikingly high when compared with other countries, [17][18][19][20][21] and show considerable unexplained regional variation. 16,22 This has led to an ongoing discussion as to whether these rates reflect the actual need for CA or whether CA is performed too frequently in patients with stable CAD as a standard diagnostic procedure, or before conservative medical therapy options are exhausted. 16,17,22,23 These deviations from national and international treatment guidelines 13,14,24 may be driven by supply structures, medical uncertainty regarding the indication, patient preferences, and established, regionally prevailing medical practice and treatment paradigms.…”

“…16,22 This has led to an ongoing discussion as to whether these rates reflect the actual need for CA or whether CA is performed too frequently in patients with stable CAD as a standard diagnostic procedure, or before conservative medical therapy options are exhausted. 16,17,22,23 These deviations from national and international treatment guidelines 13,14,24 may be driven by supply structures, medical uncertainty regarding the indication, patient preferences, and established, regionally prevailing medical practice and treatment paradigms. 16,17,22,23,25 The aim of the SSA presented in this study is to provide insight into the care process that precedes the CA and to compare it with guideline recommendations, in particular regarding the use of conservative management options.…”

“…16,17,22,23 These deviations from national and international treatment guidelines 13,14,24 may be driven by supply structures, medical uncertainty regarding the indication, patient preferences, and established, regionally prevailing medical practice and treatment paradigms. 16,17,22,23,25 The aim of the SSA presented in this study is to provide insight into the care process that precedes the CA and to compare it with guideline recommendations, in particular regarding the use of conservative management options. As a methodological contribution, we demonstrate how to jointly analyze care events of different thematic areas that can occur simultaneously, namely physician visits and medication use.…”

“…Clusters are visualized and investigated using correlation analyses. In particular, we were interested in routinely performed follow-up CAs, which are strongly discouraged by current guidelines 13,24 and can be seen as a sign of an inappropriate indication, 22,26,27 but may be still prevalent in everyday medical practice. 23,25…”