Abstract 13179: Bare Metal vs Drug Eluting Stent Choice: The Impact of Atrial Fibrillation and Setting of Care Among Medicare Beneficiaries

Abstract

Background: In treating coronary artery disease, many factors influence the choice of bare metal (BMS) or drug eluting stents (DES), including bleeding risk and suitability for prolonged dual anti-platelet therapy (DAPT). Atrial fibrillation (AF) further complicates this choice. We examined stent selection among Medicare beneficiaries by AF status to explore how cardiologists are managing this complex choice overall and how this choice varies across academic medical centers (AMC). Methods: Using a 100% Medicare denominator file and associated inpatient claims (2008-2012), we identified patients over age 65 receiving inpatient coronary artery stents. We measured BMS and DES use in AF and non-AF patients overall and assessed variation in stent choice across 50 high volume AMCs. Results: Overall, 1,269,239 stent procedures were studied. BMS, as a percent of total inpatient stents, declined from 2008 to 2012 in AF (41% to 34%) and non-AF (30% to 21%) patients. Across high volume AMCs in 2012, the proportion of stent patients receiving BMS (5th to 95th percentile) ranged from 15% to 63% in AF patients and from 8% to 37% in non-AF patients. In 2012, the AMC-level difference in BMS stent use by AF status (proportion of BMS among AF patients minus proportion BMS in non-AF patients) ranged from 4% to 35% (5th to 95th percentile). Conclusions: Among stent recipients, AF patients are more likely to receive BMS than non-AF patients but treatment varies widely across AMCs, suggesting a lack of consensus. Studies of stent choice and outcomes among AF patients are needed to guide care decisions and optimize outcomes.