Abstract
BackgroundThe volume and percentage of percutaneous coronary interventions (PCIs) performed for nonacute indications have declined in the United States since 2007. However, little is known if similar trends occurred in Taiwan.MethodsWe used data from Taiwan National Health Insurance inpatient claims to examine the regional and hospital variations in the extent of decline in the percentage of nonacute indication PCIs from 2007 to 2012.ResultsThe volume of total PCIs persistently increased from 29,032 in 2007 to 35,811 in 2010 and 37,426 in 2012. However, the volume of nonacute indication PCIs first increased from 7916 in 2007 to 9143 in 2009 and then decreased to 8666 in 2012. The percentage of nonacute indication PCIs steadily decreased from 27% in 2007 to 26% in 2009 and then to 23% in 2012, a − 15% change. The extent of decline was largest in the North region (from 27% to 21%, a − 22% change) and least in Kaopin region (from 20% to 18%, a − 13% change). Of the 71 hospitals studied, 14 did not show a decreasing trend. Five of the 14 hospitals even showed an increasing trend, with a percentage change >10% between 2007 and 2012. In 2012, 6 hospitals had a nonacute indication PCI percentage >35%.ConclusionsIn Taiwan, four-fifths of the hospitals showed a decline in the percentage of nonacute indication PCIs from 2007 to 2012. It is plausible that Taiwanese cardiologists would have been influenced by the recommendations of crucial US trials and guidelines.
Highlights
The volume and percentage of percutaneous coronary interventions (PCIs) performed for nonacute indications have declined in the United States since 2007
In Taiwan, four-fifths of the hospitals showed a decline in the percentage of nonacute indication PCIs from 2007 to 2012
In the era of globalization and evidence-based medicine, crucial trials and guidelines published in the United States might have a substantial impact on cardiologists worldwide
Summary
The volume and percentage of percutaneous coronary interventions (PCIs) performed for nonacute indications have declined in the United States since 2007. After the publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial in 2007 and the Appropriate Use Criteria for Coronary Revascularization (AUC) in 2009 [1, 2], the volume and percentage of percutaneous coronary interventions (PCIs) performed for nonacute indications (or stable ischemic heart disease, SIHD). Little is known regarding whether similar trends exist in Taiwan, a country which is on the other side of Pacific Ocean and which has a different healthcare-financing system from that of the United States. We sought to examine regional and hospital variations in the extent of decline in the proportion of PCIs performed for nonacute indications in Taiwan from 2007 to 2012. Professional organizations and insurance payers are eager to know the number and types of hospitals that did not show the expected decreasing trend after the publication of an important trial and guideline in which the assessment of the appropriateness of performed PCIs is considered necessary
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