Real-World Adherence to ACC/AHA Guidelines Studied

January 19, 2010—An analysis of actual practice of catheterization laboratory cardiologists sought to measure the adherence to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery. Edward L. Hannan, PhD, et al published the findings from this study in Circulation (2010;121:267–275). The background of the study, the investigators noted, is that the ACC and AHA have issued guidelines for CABG and PCI for many years, but little is known about the impact of these evidence- based guidelines on referral decisions.

As detailed in Circulation, the investigators used a cardiac catheterization laboratory database shared by 19 hospitals in New York State to identify treatments (CABG, PCI, medical treatment, or no treatment) recommended by the catheterization laboratory cardiologist for patients undergoing catheterization with asymptomatic/mild angina, stable angina, and unstable angina/non–ST-elevation myocardial infarction between January 1, 2005, and August 31, 2007. The recommended treatment was compared with indications for these patients based on ACC/AHA guidelines.

According to the investigators, of the 16,142 patients undergoing catheterization who were found to have coronary artery disease, the catheterization laboratory cardiologist was the final source of recommendation for 10,333 patients (64%). Of these 10,333 patients, 13% had indications for CABG surgery, 59% for PCI, and 17% for both CABG surgery and PCI. Of the patients who had indications for CABG surgery, 53% were recommended for CABG and 34% were recommended for PCI. Of the patients with indications for PCI, 94% were recommended for PCI. For the patients who had indications for both CABG surgery and PCI, 93% were recommended for PCI and 5% were recommended for CABG surgery. Catheterization laboratory cardiologists in hospitals with PCI capability were more likely to recommend patients for PCI than hospitals in which only catheterization was performed.

The investigators concluded that patients with coronary artery disease receive more recommendations for PCI and fewer recommendations for CABG surgery than indicated in the ACC/AHA guidelines.