2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Brott, Thomas G.; Halperin, Jonathan L.; Abbara, Suhny; Bacharach, J. Michael; Barr, John D.; Bush, Ruth L.; Cates, Christopher U.; Creager, Mark A.; Fowler, Susan B.; Friday, Gary; Hertzberg, Vicki; McIff, E. Bruce; Moore, Wesley S.; Panagos, Peter D.; Riles, Thomas S.; Rosenwasser, Robert H.; Taylor, Allen J.; Jacobs, Alice K.; Smith, Sidney C.; Anderson, J. Lawford; Adams, Cynthia D.; Albert, Nancy; Buller, Christopher E.; Ettinger, Steven M.; Guyton, Robert A.; Hochman, Judith S.; Hunt, Sharon A.; Krumholz, Harlan M.; Kushner, Frederick G.; Lytle, Bruce W.; Nishimura, Rick A.; Ohman, E. Magnus; Page, Richard L.; Riegel, Bárbara; Stevenson, William G.; Tarkington, Lynn G.; Yancy, Clyde W.

doi:10.1002/ccd.22983

Cited by 180 publications

(40 citation statements)

References 350 publications

(206 reference statements)

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“…In addition to being expensive, cardiovascular care has discrete, concrete treatment algorithms for imaging tests and procedures for both symptomatic and asymptomatic cardiovascular disease processes. 26, 29 We hypothesized that cardiovascular care could potentially represent an ideal specialty setting to attempt to limit discretionary procedures, especially those at the margin of plausible benefit. Marshfield Clinic and The University of Michigan Faculty Group Practice significantly reduced spending overall in the Demonstration; while there is some indication of reductions in discretionary use in these practices (e.g.…”

Section: Discussionmentioning

confidence: 99%

Implementation of a Pilot Accountable Care Organization Payment Model and the Use of Discretionary and Nondiscretionary Cardiovascular Care

et al. 2014

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Background Accountable care organizations (ACOs) seek to reduce growth in healthcare spending while ensuring high-quality care. We hypothesized that ACO implementation would selectively limit utilization of discretionary cardiovascular care (defined as care occurring in the absence of indications such as myocardial infarction or stroke), while maintaining high-quality care such as non-discretionary cardiovascular imaging and procedures. Methods and Results The intervention group was composed of fee-for-service Medicare patients (n=819,779) from 10 groups participating in a Medicare pilot ACO, the Physician Group Practice Demonstration (PGPD). Matched controls were patients (n=934,621) from non-participating groups in the same regions. We compared utilization of cardiovascular care before (2002-2004) and after (2005-2009) PGPD implementation, studying both discretionary and non-discretionary carotid and coronary imaging and procedures. Our main outcome measure was the difference in the proportion of patients treated with imaging and procedures, among patients of PGPD practices compared to patients in control practices, before and after PGPD implementation (difference-in-difference). For discretionary imaging, the difference-in-difference between PGPD practices and controls was not statistically significant for discretionary carotid imaging (0.17%; 95% CI -0.51% to 0.85%, p=0.595) or discretionary coronary imaging (-0.19%; 95% CI -0.73% to 0.35%, p=0.468). Similarly, the difference-in-difference was also minimal for discretionary carotid revascularization (0.003%; 95% CI -0.008% to 0.002%, p=0.705) and coronary revascularization (-0.02%, 95% CI -0.11% to 0.07%, p=0.06). The difference-in-difference associated with PGPD implementation was also essentially zero for non-discretionary cardiovascular imaging or procedures. Conclusions Implementation of a pilot ACO did not limit the utilization of discretionary or non-discretionary cardiovascular care in ten large health systems.

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Section: Discussionmentioning

confidence: 99%

Implementation of a Pilot Accountable Care Organization Payment Model and the Use of Discretionary and Nondiscretionary Cardiovascular Care

et al. 2014

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“…For example, the current guidelines suggest CAS and CEA be considered as treatment alternatives for severe asymptomatic carotid artery disease if they can be performed with an event rate <3% in asymptomatic patients. 12 However, if there is variation among operators, how can a study such as CREST systematically choose study operators with event rates below this level? More generally, how can a patient be assured that the “true” event rate for the specific operator is below this level?…”

Section: Methodsmentioning

confidence: 99%

Picking the Good Apples

Howard

Voeks

Meschia

et al. 2014

Stroke

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“…13 These guidelines overlap with recommendations for carotid disease and may explain the lack of association between carotid disease and stroke risk when measured at 12 months. 14 Several ongoing clinical trials are evaluating the role of single versus dual-antiplatelet therapy, as well as oral anticoagulants versus antiplatelets in TAVR cohorts with and without indications for oral anticoagulants. Whether patients with concomitant carotid disease will benefit from prolonged adjunctive antiplatelet or anticoagulant therapy is uncertain; however, subgroup analyses may provide further insight into the prognostic and therapeutic implications for TAVR in patients with concomitant carotid disease.…”

Section: Discussionmentioning

confidence: 99%