Cardiology 2013. Part II.

Alternate Journal: The Journal of thoracic and cardiovascular surgery

ISSN: 1097-685X (Electronic)

0022-5223 (Linking)

DOI: 10.1016/j.jtcvs.2013.01.026

Accession Number: 23402690

Keywords: Aged

Chi-Square Distribution

Coronary Artery Bypass/adverse effects/mortality/*standards

Coronary Artery Disease/diagnosis/mortality/surgery/*therapy

Decision Support Techniques

Female

Guideline Adherence/*standards

Health Services Accessibility/standards

Hospitals, High-Volume

Humans

Interdisciplinary Communication

London

Male

Middle Aged

Patient Care Team/standards

Patient Selection

Percutaneous Coronary Intervention/adverse effects/mortality/*standards

Physician’s Practice Patterns/*standards

Practice Guidelines as Topic/*standards

Quality of Health Care/standards

Referral and Consultation/*standards

Risk Assessment

Risk Factors

Severity of Illness Index

Societies, Medical/standards

Time Factors

Treatment Outcome

Abstract: OBJECTIVE: Joint guidelines on myocardial revascularization were published by the European Society of Cardiology and European Association for Cardiothoracic Surgery: Patients with left main stem, proximal left anterior descending, or 3-vessel disease should be discussed with a surgeon before revascularization, and ad hoc percutaneous coronary intervention has no elective indication in these categories. We assess the impact of the guidelines on referral patterns to a cardiac surgery service at a large-volume cardiac center in the United Kingdom. METHODS: Joint guidelines were published in August 2010. All patients with severe disease undergoing percutaneous coronary intervention at one institution were identified 6 months before (January to June 2010) and 6 months after (January to June 2011) their introduction. Decision-making and surgical referral were determined from minutes of multidisciplinary meeting. RESULTS: A total of 197 patients underwent elective percutaneous coronary intervention pre-guidelines, of whom 62 had severe disease. Only 6 patients (9%) were discussed at a multidisciplinary meeting before intervention. After introduction of the guidelines, elective percutaneous coronary interventions were performed in 164 patients, of whom 42 had surgical disease. Only 8 patients (17%) were discussed at a multidisciplinary meeting before intervention (P = not significant). Follow-up was a median of 480 (380-514) days for the pre-guideline group and 104 (31-183) days for the post-guideline group. Ad hoc percutaneous coronary intervention in surgical disease occurred in 8 patients (14%) pre-guidelines and was unchanged for 9 patients (26%) post-guidelines (P = not significant). CONCLUSIONS: Despite recommendation by both cardiology and cardiac surgical bodies and widespread publicity, a significant number of patients in this single-center study are not receiving optimal treatment recommended by these guidelines.

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