PHS167 - Outpatient Visits To The Cath Lab For Coronary Angiography Resulting In Minimal Action In The Short Term

Abstract

To understanding the clinical care pathway and patient characteristics of those patient visits that use the catheterization laboratory (cath lab) but do not result in a percutaneous coronary intervention (PCI) and/or coronary artery bypass surgery (CABG) procedure shortly thereafter. The target population is those patient visits that are outpatient and elective, rather than those coming in through the emergency room, or inpatient admissions. The Premier hospital database from July 1, 2011 through June 30, 2012 was utilized as the data source. This database contains complete patient billing, hospital cost, and coding histories from more than 600 hospitals and ambulatory facilities throughout the United States. Eligible patients were > age 45 at the time of the coronary angiography visit, and must have had one of the following primary diagnosis of Atherosclerosis or chest pain using the International Classification, 9th Revision (ICD-9): 414.01, 786.5, or 786.59. Patient visits with a diagnosis code(s) for myocardial infarction or stroke/trans-ischemic attack were excluded. Patients that died during the visit were excluded as well. Of 354,790 coronary angiography visits identified, 68,026 visits (19.2%) met the inclusion criteria. Only 7% of patient visits (4,788) resulted in a return visit within 60 days for a PCI (29%), CABG (71%), or both (<1%). Less than 2% (81) came back to the hospital through the ER. Total median coronary angiography cost per visit for the group of interest was $2,565, with the cardiology department accounting for 57% ($1,470) of costs. Left heart cardiac catheterization was the most common procedure (86%). There appears to be a substantial population receiving elective coronary angiography, with no immediate action resulting from that visit. Technologies that could enable another clinical pathway to avoid the cath lab and an invasive procedure may lead to lower hospital costs.