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Angiograms: Time to review guidelines for selecting patients

March 9, 2015

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New research shows that while almost half of Ontario patients with angina or heart pains receiving angiograms were found to have obstructive coronary artery disease, the criteria for patient selection could still benefit from review.

The study, published in the Annals of Internal Medicine, looked at 48,336 patients with stable ischemic heart disease, or angina, who received an angiogram, a test that takes x-ray pictures of the coronary arteries and the vessels that supply blood to the heart.

Using criteria developed in 2012 for selecting patients for angiograms, 58.2 per cent of patients were classified as appropriate, 10.8 per cent as inappropriate and 31.0 per cent as uncertain. Of those deemed appropriate, 52.9 per cent had obstructive coronary artery disease. Of those in the inappropriate grouping, 30.9 per cent were found to have obstructive coronary artery disease. Overall, 45.5 per cent of patients receiving angiograms had obstructive coronary artery disease.

“Typically we associate ‘appropriateness’ with angiograms revealing obstructive coronary artery disease, with patients going on to receive subsequent revascularization such as a stent or bypass surgery,” says Dr. Harindra Wijeysundera, principal investigator and interventional cardiologist with Sunnybrook’s Schulich Heart Centre. “Our findings suggest that it may be worth reassessing criteria to help guide clinical practice, and improve patient health outcomes in a cost-effective manner.”

Angiogram

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Angiograms: Time to review guidelines for selecting patients

Toronto, Ontario (Monday, March 9, 2015) – New research shows that while almost half of Ontario patients with angina or heart pains receiving angiograms were found to have obstructive coronary artery disease, the criteria for patient selection could still benefit from review.

The study, published in the Annals of Internal Medicine, looked at 48,336 patients with stable ischemic heart disease, or angina, who received an angiogram, a test that takes x-ray pictures of the coronary arteries and the vessels that supply blood to the heart.

Using criteria developed in 2012 for selecting patients for angiograms, 58.2 per cent of patients were classified as appropriate, 10.8 per cent as inappropriate and 31.0 per cent as uncertain. Of those deemed appropriate, 52.9 per cent had obstructive coronary artery disease. Of those in the inappropriate grouping, 30.9 per cent were found to have obstructive coronary artery disease. Overall, 45.5 per cent of patients receiving angiograms had obstructive coronary artery disease.

“Typically we associate ‘appropriateness’ with angiograms revealing obstructive coronary artery disease, with patients going on to receive subsequent revascularization such as a stent or bypass surgery,” says Dr. Harindra Wijeysundera, principal investigator and interventional cardiologist with Sunnybrook’s Schulich Heart Centre. “Our findings suggest that it may be worth reassessing criteria to help guide clinical practice, and improve patient health outcomes in a cost-effective manner.”

Dr. Wijeysundera notes that the study only looked at patients who received angiograms, so the research team is limited in drawing conclusions about overuse or underuse by commenting on the appropriateness scores of those who did not receive the test. Data was supplied by the Cardiac Care Network of Ontario and looked at patients having elective angiography at 18 hospitals in Ontario between October 2008 and September 2011. The Canadian Institutes of Health Research was the primary funder for the research.

“Our hope is that these findings will encourage future study to examine the appropriateness criteria to assist clinicians in deciding which patients are good candidates for angiography,” adds Dr. Wijeysundera.

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