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To assess trends in hospitalization rates among patients with an abnormal stress test in the eras before and after publication of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial.
Based on contemporary literature, trends in patients hospitalized for an abnormal stress test is unknown. The COURAGE trial demonstratedthat major cardiovascular events were not reduced with percutaneous coronary interventions (PCI) when added to optimal medical therapy in a population of patients with stable ischemic heart disease, including those with an “abnormal” stress test. Moreover, the impact of the COURAGE trial on the decision to treat patients in-hospital with stable ischemic heart disease and an “abnormal” stress test has not been evaluated.
We queried the Nationwide (National) Inpatient Sample (NIS) to identify patients being admitted for an “abnormal” stress test with a principal discharge ICD 9 CM diagnostic code of 794.39 from 2003 to 2014. The COURAGE trial was published in 2007. We evaluated the impact of that publication by assessing trends of in-hospital management of patients with a principal discharge diagnosis of an abnormal stress test before and after 2008 using a non-parametric test for trends.
From 2003 to 2007, there appears to have been an increase in the in-hospital management of patients with an abnormal stress test (p-trend <0.001). Since 2008, post publication of the COURAGE trial, there appears to have been significant reduction in this trend (p-trend <0.039).
There appears to be a recent reduction in the trend of in-hospital management of patients with an abnormal stress test, which appears to be co-incident with the publication of the COURAGE trial.