Author + information
- Received September 19, 2017
- Revision received December 18, 2017
- Accepted January 16, 2018
- Published online March 19, 2018.
- Andrew C. Glatz, MD, MSCEa,b,∗ (, )
- Kevin F. Kennedy, MSc,
- Jonathan J. Rome, MDa and
- Michael L. O’Byrne, MD, MSCEa,b,d
- aDivision of Cardiology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- bCenter for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
- cMid America Heart Institute St. Luke’s Health System, Kansas City, Missouri
- dLeonard Davis Institute for Health Care Policy, University of Pennsylvania, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Andrew C. Glatz, Division of Cardiology, 6th Floor, Main Building, the Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104.
Objectives The authors sought to study variation in the practice of balloon aortic (BAV) and pulmonary valvuloplasty (BPV).
Background The IMPACT (IMProving Adult and Congenital Treatment) registry provides an opportunity to study practice variation in transcatheter interventions for congenital heart disease.
Methods The authors studied BAV and BPV in the IMPACT registry from January 1, 2011, to September 30, 2015, using hierarchical multivariable models to measure hospital-level variation in: 1) the distribution of indications for intervention; and 2) in cases with “high resting gradient” as the indication, consistency with published guidelines.
Results A total of 1,071 BAV cases at 60 hospitals and 2,207 BPV cases at 75 hospitals were included. The indication for BAV was high resting gradient in 82%, abnormal stress test or electrocardiogram (2%), left ventricular dysfunction (11%), and symptoms (5%). Indications for BPV were high resting gradient in 82%, right-left shunt (6%), right ventricular dysfunction (7%), and symptoms (5%). No association between hospital characteristics and distribution of indications was demonstrated. Among interventions performed for “high resting gradient,” there was significant adjusted hospital-level variation in the rates of cases performed consistently with guidelines. For BAV, significant differences were seen across census regions, with hospitals in the East and South more likely to practice consistently than those in the Midwest and West (p = 0.005). For BPV, no association was found between hospital factors and rates of consistent practice, but there was significant interhospital variation (median rate ratio: 1.4; 95% confidence interval: 1.2 to 1.6; p < 0.001).
Conclusions There is measurable hospital-level variation in the practice of BAV and BPV. Further research is necessary to determine whether this affects outcomes or resource use.
The analysis in this manuscript was funded by the American College of Cardiology and National Cardiovascular Data Registry. The proposed project and manuscript were reviewed by the IMPACT Research and Publications Committee. The funding agencies had no role in the drafting of the manuscript or influencing its content. Dr. O’Byrne has received research support from the National Institute of Health/National Heart, Lung, and Blood Institute (K23 HL130420-01). Dr. Glatz has received research support from the Children’s Heart Foundation, the CHD Coalition, and Big Hearts to Little Hearts. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 19, 2017.
- Revision received December 18, 2017.
- Accepted January 16, 2018.
- 2018 American College of Cardiology Foundation