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Physician-level variation in the diagnosis of myocardial infarction and the use of angiography among veterans with elevated troponin

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Journal of Medical Colleges of PLA(China) 2016年第3期31卷 129-133页

作者： David E.Winchester Nayan Agarwal Lucas Burke Steven Bradley tatiana schember Carsten Schmalfuss Division of Cardiovascular Medicine University of Florida College of MedicineGainesville FLUSA Malcom Randall Veterans Affairs Medical Center GainesvilleFLUSA Division of Cardiology Department of MedicineVA Eastern Colorado Health Care SystemDenverCOUSA Department of Medicine University of Colorado School of Medicine at the Anschutz Medical CampusAuroraCOUSA.

Background:Cardiac troponin assays have improved the ability to detect myocardial ***,ascertaining whether troponin elevation is due to myocardial infarction(MI) or secondary to another process can be *** aim is to evaluate provider-level variation in the diagnosis of MI and the use of invasive coronary angiography(ICA) among patients with undifferentiated elevations in cardiac ***:We analyzed data from all patients with elevated troponin levels in a single Veterans Affairs(VA) Medical Center between 2006 and *** of several cardiologists prospectively evaluated each patient's presentation and course of *** compared the frequency of MI diagnosis and ICA use between physicians using univariate odds ratios(OR).Results:Among 761 patients,34.0% were diagnosed with MI and 25.9% underwent *** unadjusted rates of MI(23.9% to 56.7%,P=0.02) and ICA(17.3% to 73.3%,P<0.001) differed between *** the patient cohorts for each physician,baseline characteristics were similar except for chest *** multivariate regression,factors associated with the use of cardiac ICA included an abnormal electrocardiograph(ECG)(OR=1.89,P=0.014),level of troponin(OR=1.71,P=0.004),chest pain(OR=8.60,P<0.001),and care by non-VA physicians(OR=4.45,P=0.006).One physician had a lower ICA use(OR=0.56,P=0.017).In multivariate regression of MI,no physician-level variation was ***:Among patients with elevated troponin,the likelihood of being diagnosed with MI and undergoing ICA is dependent on their clinical *** adjustment,physician-level variation in care was observed for the use of ICA,but not for the diagnosis of MI.

关键词： Acute coronary syndrome Coronary angiography Variation in care Cardiac troponin

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