The Impact of Social and Institutional Characteristics on the Appropriateness of Invasive Cardiologic Procedures

Abstract

Social characteristics of patients and institutional characteristics have only a marginal impact on the indication of invasive cardiologic procedures. A trend toward "overdiagnostics" within the group of younger patients has been noticed, even in the case of missing hard medical evidence. A serious deficit of health care research can be found. Consented criteria to assess the appropriateness of medical treatments are missing. More research has to be done in the field of concepts and processes controlling the distribution and movement of patients into different sections of the health care system. Validated, standardized and comprehensive data for an international comparison of decisions about medical treatments are needed.

Evidence for overuse of medical services around the world

“…124 Inappropriate percutaneous coronary intervention has been documented in many countries, with prevalence of 4–12% in the US; 55,125 10%–14% in Germany, 126,127 16% in Italy; 128 22% in Israel; 7 20% in Spain; 6 and 3.7% in Korea. 129 In one second-opinion centre in India, 55% of recommended cardiac stents or surgery were deemed inappropriate.…”

Inequalities in therapeutic treatment during cardiac inpatient rehabilitation in Germany

“…In Germany, no comparable findings exist. Brause et al (2006), for example, found no substantial differences in the provision of adequate invasive cardiac procedures.…”

How socioeconomic inequalities impact pathways of care for coronary artery disease among elderly patients: study protocol for a qualitative longitudinal study

“… 20–22 Altenhöner studied socioeconomic inequalities in access, utilisation and quality of rehabilitation for patients with CAD in Germany; he established that CR procedures are used less frequently by patients of a lower SES. 23 Conversely, a study by Brause et al 24 found no socioeconomic difference for the appropriateness of a medical indication for coronary interventions in Germany.…”