Variations in Practice Patterns of Balloon Aortic and Pulmonary Valvuloplasty Analyzed in the IMPACT Registry
March 27, 2018—In Journal of the American College of Cardiology (JACC): Cardiovascular Interventions, Andrew C. Glatz, MD, et al published findings from the IMPACT (Improving Adult and Congenital Treatment) registry that is designed to evaluate practice variation in transcatheter interventions for congenital heart disease (2018;11:529–538).
In this analysis, the investigators studied variations in the practice of balloon aortic valvuloplasty (BAV) and balloon pulmonary valvuloplasty (BPV). They concluded that there is measurable hospital-level variation in the practice of BAV and BPV and advised that further research is necessary to determine whether this affects outcomes or resource use.
As summarized in JACC: Cardiovascular Interventions, the investigators studied BAV and BPV in the IMPACT registry from January 1, 2011 to September 30, 2015. They used hierarchical multivariable models to measure hospital-level variation, in the distribution of indications for intervention, and in cases with “high resting gradient” as the indication, consistent with published guidelines.
A total of 1,071 BAV cases at 60 hospitals and 2,207 BPV cases at 75 hospitals were included in the analysis. Indications for BAV were high resting gradient (82% of patients), abnormal stress test or electrocardiogram (2%), left ventricular dysfunction (11%), and symptoms (5%). Indications for BPV were high resting gradient (82%), right-to-left shunt (6%), right ventricular dysfunction (7%), and symptoms (5%). No association between hospital characteristics and distribution of indications was demonstrated.
The investigators found that among interventions performed for “high resting gradient,” there was significant adjusted hospital-level variation in the rates of cases performed consistently with guidelines. For BAV, significant differences were seen across census regions, with hospitals in the East and South more likely to practice consistently than those in the Midwest and West (P = .005). For BPV, no association was found between hospital factors and rates of consistent practice, but there was significant interhospital variation (median rate ratio, 1.4; 95% confidence interval, 1.2–1.6; P < .001), reported the investigators in JACC: Cardiovascular Interventions.