information

Hospitals seem to be all over the charts when it comes to a very serious and invasive procedure that detects obstructive coronary artery disease (CAD) in people without known heart disease. A new study reports that some U.S. hospitals state that 100% of patients undergoing this procedure were found to have CAD, others had rates as low as 23%, meaning the majority of patients selected for elective catheterization did not have blockages. Researchers are calling for further efforts to improve the patient selection and decision making processes used by institutions to limit exposure to costly, invasive procedures when not necessary.

Obstructive coronary artery disease (CAD) is a chronic, progressive form of heart disease that results from atherosclerosis, or a buildup of damaging plaque in the arteries found on the surface of the heart. The arterial plaque that characterizes obstructive coronary artery disease obstructs the flow of blood to the heart. Heart attack or death may result.

The study is the first to investigate the degree to which hospitals differ in the rate of discovering CAD with coronary angiography and the factors that might predict this. Hospital-level variability appears to be predictable based on differing patterns of patient selection and pre-catheterization evaluation, testing and treatment

Pamela S. Douglas, MD, Ursula Geller Professor of Cardiovascular Research, Duke Clinical Research Institute, Durham, North Carolina explains:

"This procedure has associated costs and it's not without risk. The decision to perform catheterization should be selective and ideally limited to patients with moderate to high pre-test probability for CAD. This study is an important step in assessing quality of care and is integral to efforts to improve it. Our findings indicate that there may be an opportunity to increase the likelihood of finding CAD at catheterization, and perhaps reduce the number of procedures that don't find disease. Because hospitals maintained a similar rate of finding disease relative to other hospitals year in and year out, and these rates are also related to patient characteristics, it suggests that decision-making processes and clinical practice patterns are a highly influential factor guiding the use of diagnostic coronary angiography and could be a target for quality improvement efforts."

Researchers identified 565,504 patients without known heart disease who underwent elective cardiac catheterization at 691 hospitals nationwide over a three-year-period to evaluate the rate of finding obstructive CAD. Authors defined CAD as any major epicardial vessel stenosis at 50% or higher, but similar patterns remained even when alternate definitions were applied.

Dr. Douglas advocates for closer consideration of those clinical factors known to be most strongly associated with CAD, including advancing age, risk factors and typical symptoms. A careful assessment of patients' risk and presenting symptoms, as well as results of any stress and other non-invasive tests should be considered.

Early in the development of atherosclerosis, fatty streaks form on artery walls. Substances traveling in the bloodstream eventually build up as plaque, filling the lumen, or hollow, of the artery and interfering with blood flow. Obstructive coronary artery disease may begin in childhood if there is a family history of early development. Other risk factors include smoking, high levels of fat and cholesterol in the blood, high blood pressure, lack of exercise and excess weight.

Angina pectoris, or sudden chest pain, is often the first sign of obstructive coronary artery disease. It may be because of a plaque rupture or acute myocardial infarction (heart attack). Treatment includes lifestyle modifications and medications to correct some of the risk factors and may include coronary artery bypass surgery.

Written by Sy Kraft
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
source :www.medicalnewstoday.com