Appropriate utilization of percutaneous coronary interventions (PCI) has been a hot topic among cardiovascular leaders over the past few years (and a common topic on this blog). A recent meta-analysis of eight trials published in the Archives of Internal Medicine promises to add more fuel to the debate by suggesting that patients with stable coronary artery disease (CAD) fare no better with PCI than medical management. Rather than sending patients directly to the cath lab, study authors suggest medical therapy as a first line of defense given the lack of benefit found in treating stable CAD with costly interventions.
Overall, the study found no significant difference in the risk of death, nonfatal MI, unplanned coronary revascularization or angina when the two treatments were compared. The meta-analysis combined data from eight contemporary trials such as the COURAGE, OAT, and BARI 2D studies. All told, 7,229 patients were evaluated, half of whom were randomized to receive both PCI and medical therapy, and half of whom were randomly chosen to receive medical therapy alone. Three of the five studies enrolled patients with stable CAD following an MI while the rest enrolled patients with stable angina and/ or ischemia following a stress test.
PCI offers no benefits over medical management of stable CAD
The use of evidence-based, guideline-recommended therapies for heart failure can be associated with reduced risk of mortality over two years, with an incremental benefit observed with successive treatments, according to a new analysis of the IMPROVE-HF registry published in the Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease. This study offers further evidence in support of adherence to evidence-based guidelines in heart failure patients in real-world settings, as well as more specific insight into efficacy of guideline-based therapies individually and in combination.
Adherence to (most) guideline-recommended HF therapies reduces risk of mortality
Earlier this month, the National Quality Forum (NQF) endorsed four new measures aimed at tracking resource utilization within certain patient populations. The measures center on diabetes and cardiovascular care costs, requiring organizations to measure per member per month expenditures within each cohort. Maybe not surprisingly, CMS intends to add a similar measure to their VBP program aimed at isolating Medicare spending per beneficiary (MSPB).
These tandem efforts to redefine value of care may be indicators of what’s to come—increased scrutiny over total-cost-of-care management. As risk begins to shift towards providers with the advent of new payment models, organizations must learn to both understand and then inflect total cost of care in order to remain financially viable.
NQF endorses four new measures to redefine value of care