Multiple procedures and cumulative individual radiation exposure in interventional cardiology: A long-term retrospective study

Weltermann, Birgitta; Rock, Thomas; Brix, Gunnar; Schegerer, Alexander; Berndt, Peter; Viehmann, Anja; Reinders, Sabrina; Gesenhues, Stefan

doi:10.1007/s00330-015-3672-9

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Overuse of CC is not only risky for patients in the short term but is potentially associated with avoidable radiation exposure. A German study on multiple procedures and cumulative individual radiation exposure in interventional cardiology calculated exposures of up to 185 mSV in individual patients 7. Also, it is assumed that at least US$158 billion are spent on unnecessary treatments,8 that is, 30% of healthcare expenditures in the USA are preventable 9.…”

Section: Introductionmentioning

confidence: 99%

Patient factors driving overuse of cardiac catheterisation: a qualitative study with 25 participants from two German teaching practices

2019

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ObjectivesPercutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. However, an overuse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other countries. In this study, we aim to understand patient factors that foster this overuse.DesignOur study is an exploratory qualitative interview study with narrative, structured interviews. The interviews were analysed using qualitative content analysis by Mayring.SettingThe interviews were conducted in two German teaching practices.Participants24 interviews with 25 patients were conducted; 17 (68%) patients were male, the average age was 73.9 years (range 53–88 years). All patients suffered from CAD and had undergone at least one CC. Patients with known anxiety disorders were excluded from the study.ResultsThe analysis identified six patient factors which contributed to or prevented the overuse of CC: (1) unquestioned acceptance of prescheduled appointments for procedures/convenience; (2) disinterest in and/or lack of disease-specific knowledge; (3) helplessness in situations with varying opinions on the required care; (4) fear of another cardiac event, (5) patient–physician relationship and (6) the patient’s experience that repeat interventions did not result in a change of health status or care.ConclusionsConducted in a country with documented overuse of CC, we showed that most patients trusted their physicians’ recommendations for repeat coronary angiographies even if they were asymptomatic. Strategies to align physician adherence with guidelines and corresponding patient information are needed to prevent overuse.

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Section: Introductionmentioning

confidence: 99%

Patient factors driving overuse of cardiac catheterisation: a qualitative study with 25 participants from two German teaching practices

2019

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“…In a retrospective study of 147 individual patient careers spanning back up to 28 years, we showed that patients with more than 10 CCs in a lifetime had a higher rate of procedures classified as ‘low appropriateness’ (72%) compared with those with fewer procedures (20% in 1–5 procedures and 52% in 6–9 procedures). 12 …”

Section: Introductionmentioning

confidence: 99%

Study protocol for a matter of heart: a qualitative study of patient factors driving overuse of cardiac catheterisation

Herwig

Weltermann

2017

BMJ Open

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IntroductionOveruse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other regions, although percutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. Various studies investigated health system, physician and patient factors driving non-adherence to guidelines which recommend a stepwise approach with invasive procedures only in case of signs of ischaemia in non-invasive testing. In a larger-scale project, we aim to better understand the patients’ perspective in order to develop an intervention that enhances patient’s acceptance of this stepwise diagnostic approach for stable CAD. As a first step, this qualitative study aims to identify patient factors that prevent and promote the described overuse.Methods and analysisThe exploratory qualitative interview study will include about 20 patients with stable CAD and a history of acute coronary syndrome from two German teaching practices. Narrative, structured interviews designed to last 30 to 90 min will be conducted. The interviews will be analysed using qualitative content analysis by Mayring. The analysis will address the following questions: (1) What are reasons for stable patients to undergo CC? (2) How do patients deal with their heart disease (secondary prevention)? (3) Which processes do patients describe regarding decision-making for non-invasive and invasive coronary procedures? (4) What information needs exist on behalf of patients to better understand the stepwise diagnostic approach outlined in guidelines and thereby avoid low-appropriate CCs? Based on these data, empirical typification will be conducted.Ethics and disseminationEthical approval for the study was obtained. All participants will provide written informed consent. Data will be pseudonymised for analysis. The findings will contribute to the development of an appropriate intervention. Results will be disseminated by conference presentations and journal publications.

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Radiation Training, Radiation Protection, and Fluoroscopy Utilization Practices Among US Therapeutic Endoscopists

et al. 2019

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Multiple procedures and cumulative individual radiation exposure in interventional cardiology: A long-term retrospective study

Cited by 3 publications

References 29 publications

Patient factors driving overuse of cardiac catheterisation: a qualitative study with 25 participants from two German teaching practices

Patient factors driving overuse of cardiac catheterisation: a qualitative study with 25 participants from two German teaching practices

Study protocol for a matter of heart: a qualitative study of patient factors driving overuse of cardiac catheterisation

Radiation Training, Radiation Protection, and Fluoroscopy Utilization Practices Among US Therapeutic Endoscopists

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