If you want the best technology available to relieve blocked blood flow to the heart, the choice is a drug-eluting stent.
And you are most likely to obtain the drug-eluting stent for reasons that have nothing to do with your medical condition, a new Mayo Clinic study shows. In fact, if you are a heart patient seeking care in an urban center, or a center in the northeastern United States, you are twice as likely to receive a drug-eluting stent than would a patient with the similar medical condition seeking care in a rural or Midwest hospital.
Mayo Clinic also found that:
- If you carry private third-party health insurance, you are more likely than a Medicare/Medicaid patient is to receive a drug-eluting stent for similar medical conditions for which a drug-eluting stent is approved.
- Patients covered by Medicaid and Medicare tend to receive a non-drug-coated or bare metal stent form that costs one-third as much as a drug-eluting stent. Studies show bare-metal stents tend to require more repeat procedures -- either repeat stents or bypass surgery, and these add to health care costs.
- Hospitals that do a high volume of stent procedures tend to use drug-eluting stents more frequently; hospitals with lower procedural volumes tend to use more bare-metal stents.
- Hospitals that serve a large proportion of Medicaid and Medicare patients are less likely to use drug-eluting stents on any of their patients.
This is the most detailed and definitive study to identify striking differences in usage patterns of cardiac stent placements across the United States due to nonclinical factors such as insurance plan type, procedural volume and hospital geographic location. The large study analyzed 2004/2005 data involving approximately 236,000 patients in 199 non-profit hospitals. Results were presented March 27 at the American College of Cardiology's 56th Annual Scientific Session in New Orleans. The data provide timely perspective on a topic that has been in the news recently -- the role of stents in cardiac care. "In medicine, we like to think that clinical factors matter most in determining health care," says Kirsten Hall Long, Ph.D., the Mayo Clinic investigator leading the study. "But what our study found questions this notion. Not only did we find that patients who had managed care, or fee-for-service insurance were much more likely to have a drug-eluting stent than patients covered by a government payer -- we found that certain characteristics of the hospital itself were very strongly associated with the likelihood of receiving a drug-eluting stent, such as its location or its procedural volume."
Adds Henry Ting, M.D., of Mayo Clinic and a co-author of the study: "The influence of insurance payer type and hospital type appears to be critical determinants for use of expensive health care supplies, perhaps even more important than previously described demographic characteristics including age, gender and race that contribute to differential health care services."