MONDAY, July 26 (HealthDay News) -- There are significant regional variations in the odds of Medicare beneficiaries undergoing a carotid revascularization procedure, according to research published in the July 26 issue of the Archives of Internal Medicine.
Manesh R. Patel, M.D., of the Duke University School of Medicine in Durham, N.C., and colleagues analyzed Medicare claims for both carotid endarterectomy and carotid stenting from 2003 through 2006. The main outcome measures included annual rates of carotid endarterectomy and carotid stenting, the mortality rate at 30 days and one year post-procedure, and the factors associated with the use of carotid revascularization.
The researchers found that the rate of endarterectomy declined from 3.2 to 2.6 per 1,000 person-years over the study period, while the rate of carotid stenting increased from 0.3 procedures per 1,000 patients in 2005 (the first year this code was seen in the Medicare data) to 0.4 per 1,000 patients in 2006. The East North Central region of the United States had the highest odds of endarterectomy (odds ratio, 1.60), as well as the highest odds of carotid stenting (odds ratio, 1.61), compared to New England. Prior endarterectomy and coronary artery disease were strong predictors of the use of carotid stenting instead of endarterectomy. Mortality was higher for stenting at 30 days (2.3 versus 1.2 percent for endarterectomy) and at one year (10.3 versus 6.8 percent).
"Since carotid atherosclerosis increases with age, an aging population combined with increases in vascular and brain imaging means more cases of asymptomatic carotid stenosis will be discovered. 'Mission creep' toward stenting for patients at 'average' risk is also likely to follow," writes the author of an accompanying editorial. "Because carotid revascularization is a 'preference-sensitive condition,' evidence-based decision aids should be developed to inform patients about the pros and cons of all their treatment options so that their preferences (and not just those of their physician) are heavily factored into a shared decision about treatment."
Several study authors disclosed financial ties to pharmaceutical and medical device companies.
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