Title

Predictors of FFR Underutilization

Document Type

Presentation

Publication Date

3-29-2020

Publication Title

JACC (Journal of the American College of Cardiology)

Keywords

cards

Abstract

Background

Despite guidelines supporting FFR/iFR to guide PCI, these modalities remain underutilized. We sought to characterize factors associated with FFR/iFR use in patients undergoing index PCI for an acute coronary syndrome (ACS) or stable ischemic heart disease (SIHD).

Methods

ICD-9/10 codes were used to identify patients undergoing PCI and receiving FFR/iFR for an ACS (n=1,042,896) or SIHD (n=255,213) in a Medicare claims database from Jan. 1, 2013-June 30, 2018. Patients with functional/anatomical testing were excluded (5d prior in ACS; 60d prior in SIHD). Individuals with FFR/iFR performed 1-60 days prior to PCI were also excluded to limit analysis to non-staged procedures.

Results

FFR/iFR was performed the same day as PCI in 5.9% and 11.5% of patients with an ACS and SIHD, respectively. FFR/iFR was less likely to be utilized in patients that were >65 years, male, and in those with diabetes, chronic kidney disease or peripheral arterial disease. Of note, a substantial proportion of physicians were non-utilizers of FFR/iFR in ACS (23.9%) and SIHD (18.6%). Use of FFR/iFR was inversely correlated with years since medical school graduation, with the lowest rate observed in physicians >=31 years since graduation (Table).

Conclusion

This analysis highlights the underutilization of FFR/iFR. Identification of patient- and physician-factors associated with lower rates of FFR/iFR can be helpful to target areas for improvement to increase implementation of this guideline-recommended intervention.

Clinical Institute

Cardiovascular (Heart)

Department

Cardiology

Department

Center for Cardiovascular Analytics, Research + Data Science (CARDS)


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