作者试图研究球囊主动脉(BAV)和肺动脉瓣成形术(BPV)的实践变化。
IMPACT(IMProving成人和先天性治疗)注册为研究先天性心脏病经导管介入治疗的实践差异提供了机会。
作者从2011年1月1日至2015年9月30日在IMPACT注册中研究了BAV和BPV,使用分层多变量模型来测量医院水平的变化:1)干预适应症的分布;2)在以“高静息梯度”为适应症的情况下,与已发布的指南保持一致。
共纳入60家医院的1,071例BAV病例和75家医院的2,207例BPV病例。BAV的适应症是82%的高静息梯度,异常压力测试或心电图(2%),左心功能不全(11%),症状(5%)。BPV的适应症是82%的高静息梯度,右-左分流(6%),右心室功能障碍(7%),症状(5%)。未证明医院特征与适应症分布之间存在关联。在对“高静息梯度”进行的干预中,“在符合指南的情况下,调整后的医院级别差异很大。对于BAV,人口普查地区之间存在显着差异,东部和南部的医院比中西部和西部的医院更有可能坚持执业(p=0.005)。对于BPV,在医院因素和一致实践率之间没有发现关联,但存在显著的医院间变异(中位比率:1.4;95%置信区间:1.2~1.6;p<0.001).
在BAV和BPV的实践中存在可测量的医院水平差异。需要进一步研究以确定这是否会影响结果或资源使用。
The authors sought to study variation in the practice of balloon aortic (BAV) and pulmonary valvuloplasty (BPV).
The IMPACT (IMProving Adult and Congenital Treatment) registry provides an opportunity to study practice variation in transcatheter interventions for congenital heart disease.
The authors studied BAV and BPV in the IMPACT registry from January 1, 2011, to September 30, 2015, using hierarchical multivariable models to measure hospital-level variation in: 1) the distribution of indications for intervention; and 2) in cases with \"high resting gradient\" as the indication, consistency with published
guidelines.
A total of 1,071 BAV cases at 60 hospitals and 2,207 BPV cases at 75 hospitals were included. The indication for BAV was high resting gradient in 82%, abnormal stress test or electrocardiogram (2%), left ventricular dysfunction (11%), and symptoms (5%). Indications for BPV were high resting gradient in 82%, right-left shunt (6%), right ventricular dysfunction (7%), and symptoms (5%). No association between hospital characteristics and distribution of indications was demonstrated. Among interventions performed for \"high resting gradient,\" there was significant adjusted hospital-level variation in the rates of cases performed consistently with
guidelines. For BAV, significant differences were seen across census regions, with hospitals in the East and South more likely to practice consistently than those in the Midwest and West (p = 0.005). For BPV, no association was found between hospital factors and rates of consistent practice, but there was significant interhospital variation (median rate ratio: 1.4; 95% confidence interval: 1.2 to 1.6; p < 0.001).
There is measurable hospital-level variation in the practice of BAV and BPV. Further research is necessary to determine whether this affects outcomes or resource use.