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Eur J Cardiothorac Surg 2003;24:571-577
© 2003 Elsevier Science NL

Appropriateness of invasive cardiovascular interventions in German hospitals (2000–2001): an evaluation using the RAND appropriateness criteria

Institute of Health Economics and Clinical Epidemiology, University of Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany

Received 20 February 2003; received in revised form 23 April 2003; accepted 17 July 2003.

^* Corresponding author. Tel.: +49-221-46867-20; fax: +49-221-46867-10
e-mail: afschin.gandjour{at}medizin.uni-koeln.de

Objective: Germany has the highest per capita rate of percutaneous transluminal coronary angioplasties (PTCAs) in Europe and the third highest per capita rate of heart surgeries requiring a heart–lung machine. The goal of this study was to evaluate the appropriateness of PTCA, coronary artery bypass graft (CABG), and carotid endarterectomy (CEA) in German hospitals using RAND appropriateness criteria. Methods: A retrospective study in 121 randomly selected German hospitals (52% of all hospitals contacted) was performed from December 2000 to August 2001. A total of 361 patients were enrolled providing information on the appropriateness of 128 PTCAs, 92 CABGs, and 141 CEAs. Results: Inappropriateness rates were 2% (95% CI 0–5%), 4% (95% CI 1–9%), and 3% (95% CI 1–7%) for PTCA, CABG, and CEA, respectively. The overall rate of uncertain procedures was 42% (95% CI 36–47%). Only 38% (95% CI 32–45%) of patients who received a coronary intervention had had a pre-interventional stress test. Conclusions: The study yielded little overt overuse in the performance of PTCAs, CABGs, and CEAs, but potentially large underuse of stress tests. Despite a high per capita rate of invasive cardiovascular interventions in Germany, the rate of inappropriate procedures was not larger than in other countries.

Key Words: Percutaneous transluminal coronary angioplasty • Coronary artery bypass • Carotid endarterectomy