Trends in PCI Volume after Negative Results from the COURAGE Trial
Article first published online: 5 JUL 2013
© Health Research and Educational Trust
Health Services Research
Volume 49, Issue 1, pages 153–170, February 2014
How to Cite
Howard, D. H. and Shen, Y.-C. (2014), Trends in PCI Volume after Negative Results from the COURAGE Trial. Health Services Research, 49: 153–170. doi: 10.1111/1475-6773.12082
- Issue published online: 17 JAN 2014
- Article first published online: 5 JUL 2013
- Medical decision making;
- utilization of services;
- technology adoption;
To describe trends in the use of percutaneous coronary intervention (PCI) following the COURAGE trial, which found that medical therapy is as effective as PCI for patients with stable angina.
We used the National Hospital Discharge Survey; inpatient and outpatient discharge data from Florida, Maryland, and New Jersey; and the English Hospital Episode Statistics database.
We report trends in PCI volume by diagnosis (stable angina vs. unstable angina or AMI) before and after publication of the COURAGE trial.
The number of PCIs in patients without a diagnosis of AMI or unstable angina in Florida, Maryland, and New Jersey declined from 48,000 in 2006 to 40,000 in 2008 (−17 percent). There was no change in the number of PCIs in patients with a diagnosis of AMI. We observed similar patterns in U.S. community hospitals. PCI volume did not decline in England.
PCI volume declined after publication of the COURAGE trial. The experience of the COURAGE trial suggests that comparative effectiveness research can lead to cost-saving changes in medical practice patterns. However, there are many patients with stable coronary disease who continue to receive PCI post-COURAGE.