Coronary procedures in German hospitals: a detailed analysis for specific patient clusters

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• 作者：Kurt Bestehorn ; Timm Bauer ; Eckart Fleck…
• 关键词：Coronary procedures ; Coronary angiography ; PCI ; Patient clusters
• 刊名：Clinical Research in Cardiology
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：104
• 期：7
• 页码：555-565
• 全文大小：842 KB
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• 作者单位：Kurt Bestehorn (1)
  Timm Bauer (2)
  Eckart Fleck (3)
  Maike Bestehorn (4)
  Jürgen Pauletzki (5)
  Christian Hamm (2)
  
  1. Institut für klinische Pharmakologie, TU Dresden, Fiedlerstr. 27, 01307, Dresden, Germany
  2. Klinik für Kardiologie-Angiologie, Universit?tsklinik Gie?en-Marburg, Standort Gie?en, 35392, Giessen, Germany
  3. Klinik für Innere Medizin, Kardiologie, Deutsches Herzzentrum Berlin, 13353, Berlin, Germany
  4. ProMedCon GmbH, 82067, Ebenhausen, Germany
  5. AQUA Institut für Angewandte Qualit?tsf?rderung und Forschung im Gesundheitswesen, 37073, G?ttingen, Germany
  
• 刊物主题：Cardiology;
• 出版者：Springer Berlin Heidelberg
• ISSN：1861-0692

文摘

Objectives Evaluation of the classification of the patients with coronary procedures [CP: coronary angiography (CA) and/or percutaneous coronary intervention (PCI)] in Germany to provide valid data as a basis for the evaluation of resource planning and comparison of results from other countries. Background In the case of CP, most data are restricted to procedures related to acute coronary syndrome (ACS), either STEMI or NSTEMI, and does not cover the whole range of coronary angiographies and therapeutic procedures. To contribute to the clarification of this situation, our analysis was performed. Methods The data of all patients with CP documented according to § 137 German Social Security Code V (SGB V) by hospitals registered under the requirements of § 108 SGB V were analyzed. By cluster analysis, the most important predictors for four short-term clinical outcomes (intra-procedural and post-procedural events, death, length of hospital stay) were identified. Differences were analyzed on a national, federal state and interstate level. Results In 2012, 764,233 CP were performed in 733,337 patients (64.7?% males) in 890 hospitals. In 88.2?% of all patients, a cardiac disease was detected; in 11.3?%, it was excluded. 5 clusters were identified which were based on the following parameters: ACS, invasive coronary procedure, cardiac disease (i.e., hypertensive cardiac disease, cardiomyopathy, aortic aneurysm, cardiac valve disease), exclusion of CHD. There were significant differences between the five patient clusters: percentages of patients with diabetes, renal insufficiency and CHF varied between 14.1 and 32.9?%, 9.5 and 31.6?%, and 7.0 and 16.9?%, respectively; average duration of hospitalization and death rates varied between 5.5 (without ACS) and 8?days (ACS) and 0.3 and 4.5?%, respectively. The distribution of patient clusters varied significantly between the German federal states as well as within a federal state. Conclusions Five patient clusters with CP showed significantly differing profiles of risk, outcome and resource consumption as well as a regional distribution. This has to be considered for comparisons between hospitals as well as on a regional and international level and hospital planning.