Abstract P51: Trends in Utilization of Invasive Cardiac Procedures in North Carolina

Background: Concerns around utilization of coronary revascularization remain in the US. We aimed to understand the temporal trends and variation in invasive diagnostic cardiac catheterization (Cath), percutaneous intervention (PCI) and coronary artery bypass surgery (CABG) in North Carolina from 2003-2009. Methods: All Cath, PCI, and CABG procedures performed in North Carolina from 2003-2009 were identified using hospital-reported data submitted in a License Renewal Application by all catheterization labs for the North Carolina State Medical Facilities Plan. Rates of procedure use, ratios of PCI to Cath, CABG to Cath, and CABG to PCI were compared over time and between hospitals. Hospitals that performed at least 25 Cath, 25 PCI, and 25 CABG were included in the variation analysis. Results: From 2003-2009, there was an observed decline in the annual rate of all procedures, 16% for Cath, 9% for PCI, 27% for CABG. However, the ratio of PCI to diagnostic Cath over the time period increased by 10%, rising to 51% in 2009, while the ratio of CABG to Cath decreased by 10% (see Figure). Of the 119 hospitals in North Carolina, 21 hospitals reported performing more than 25 Cath, 25 PCI and 25 CABG each year from 2003-2009. Hospital level analysis also showed evidence of significant variation in the ratio of both PCI to Cath (10% to 90%, p<0.05) and CABG to Cath (5-35%, p<0.05). Conclusions: Although the use of all cardiac procedures declined, the ratio of PCI to Cath increased over the study period. There was significant variation in the mode of revascularization (CABG and PCI) across hospital systems in North Carolina. Further investigation into revascularization decisions is warranted. Figure.Trends in Volume and Rates of Diagnostic Cath, PCI, and CABG in North Carolina from 2003-2009.