Many of the procedures, Chan thinks, occur when patients turn 50 or 60 and realize they should have a physical exam. "And the doctor says, oh, you're now 60. We should get a stress test to see if you're at risk," even though that age alone would not pass criteria muster.
To make matters worse, some of the patients in the registry study who had PCI procedures that were labeled inappropriate "were not only asymptomatic, but they had normal stress tests too, which makes it even more of a head scratcher why they were getting them to begin with."
Chan and his research team were unable to dig deeper because the ACC's registry cases are de-identified.
Researchers are trying to find out more, Chan says. For starters, a paper in the works, perhaps to be released next March, will look at regional variation for these procedures, and may even highlight specific hospitals with higher rates of PCI that are inappropriate.
Another research project unfolding soon will tell whether cardiologists are performing "inappropriate" procedures in fewer patients, because perhaps more doctors are getting the message.
"Everybody is talking about this"
"We're still running the analyses, so we don't know the definitive answer, but the likelihood is that there probably has been improvement, and the proportion of inappropriate procedures has decreased," Chan says. "Probably because, as a lot of hospitals that I've spoken to have said, everybody is talking about this."