A recent publication in JAMA Internal Medicine by Malik et al.¹ calculate the impact of the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) results if incorporated into updated appropriate-use criteria for the frequency of rarely appropriate percutaneous coronary intervention (PCI) in stable, asymptomatic patients. Based on these calculations, the expected reduction in PCI procedures for stable, asymptomatic patients would be sevenfold.

In an accompanying article, Howard et al.² suggest that investigations of unnecessary PCI may have contributed to parallel reductions in non-investigated hospitals, although declines would have likely fallen secondary to the results of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial. It goes without stating that inappropriate PCI and/or incorrect documentation cannot be tolerated, but the effect that governmental contractual investigations have on in non-investigated hospitals must be examined.

References

1. Malik AO, Spertus JA, Patel MR, et al. Potential Association of the ISCHEMIA Trial With the Appropriate Use Criteria Ratings for Percutaneous Coronary Intervention in Stable Ischemic Heart Disease. JAMA Intern Med 2020;Sep 21:[Epub ahead of print].
2. Howard DH, Desai NR. US False Claims Act Investigations of Unnecessary Percutaneous Coronary Interventions. JAMA Intern Med 2020;Sep 21:[Epub ahead of print].

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Coronary Angiography, Percutaneous Coronary Intervention, Medicare, Drug Evaluation, Hospitals, Patient Care

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