Abstract 370: Temporal Variation in Clopidogrel Filling Delays after Percutaneous Coronary Intervention Hospital Discharge: Insights from the VA CART
Background: A prior study demonstrated significant variation between hospitals in the proportion of patients who delay filling a clopidogrel prescription after percutaneous coronary intervention (PCI). We assessed whether this variation changes over time.
Methods: Using national data from the VA Clinical Assessment Reporting and Tracking (CART) Program, we determined the hospital proportion of patients with a clopidogrel filling delay at the 62 VA cath labs performing at least 20 PCI annually between October 1, 2009 and September 30, 2012. Delay was defined as filling a clopidogrel prescription any time after the day of PCI hospital discharge. We categorized hospitals into quintiles based on the proportion of patients with delay in 6-month time intervals for each hospital and assessed whether hospitals changed quintiles over time.
Results: There were 31,002 PCIs performed from 2009-2012 at 62 PCI sites with an average number of 170.3 (sd. 99.3, median149.5) PCIs performed annually. Patient characteristics included: average age 65.2 ±9.0, 1.7% were women, 48.0% were diabetic, and 33.6% had prior history of MI. 26.7% (n=8,272) of PCIs were performed for acute coronary syndrome (ACS). The mean and median proportion of patients who delayed was 9.2% (7.5%) and by quintiles was: Q5 - 16.6% (15.3%), Q4 - 11.3% (10.2%), Q3 - 8.3% (7.8%), Q2 - 6.4% (6.2%), Q1 - 3.5% (3.6%). Over the 3 years of follow-up, 14 sites remained in the same quintile (9 in the highest, 1 in the third, 1 in the second, and 3 in the lowest quintile) and 48 sites moved between quintiles. In addition, 18 hospitals had increasing proportion of patients with delay, 14 hospitals had decreasing, while the rest of the hospitals (n=30) had fluctuating proportions of patients with delay over time.
Conclusion: There is significant temporal variation in clopidogrel delays across PCI hospitals. Future studies should assess what types of processes of care are being implemented at hospitals with low or decreasing rates of clopidogrel delay over time. In addition, these finding highlight an opportunity to implement quality improvement efforts at hospitals with persistently high or increasing rates of clopidogrel delay over time.
Figure 1. Hospital Level Proportion of Delay in 14 Sites That Stayed Within Quintile
Author Disclosures: M.S. McCreight: None. C.I. O'Donnell: None. M.E. Plomondon: None. S.M. Bradley: None. H.B. Bosworth: None. R.E. Halligan: None. D.E. Tumbiolo: None. D.Y. Lu: None. H. Jneid: None. J.S. Rumsfeld: None. P. Ho: None.
- © 2014 by American Heart Association, Inc.