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Coronary procedures in German hospitals: a detailed analysis for specific patient clusters

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Abstract

Objectives

Evaluation of the classification of the patients with coronary procedures [CP: coronary angiography (CA) and/or percutaneous coronary intervention (PCI)] in Germany to provide valid data as a basis for the evaluation of resource planning and comparison of results from other countries.

Background

In the case of CP, most data are restricted to procedures related to acute coronary syndrome (ACS), either STEMI or NSTEMI, and does not cover the whole range of coronary angiographies and therapeutic procedures. To contribute to the clarification of this situation, our analysis was performed.

Methods

The data of all patients with CP documented according to § 137 German Social Security Code V (SGB V) by hospitals registered under the requirements of § 108 SGB V were analyzed. By cluster analysis, the most important predictors for four short-term clinical outcomes (intra-procedural and post-procedural events, death, length of hospital stay) were identified. Differences were analyzed on a national, federal state and interstate level.

Results

In 2012, 764,233 CP were performed in 733,337 patients (64.7 % males) in 890 hospitals. In 88.2 % of all patients, a cardiac disease was detected; in 11.3 %, it was excluded. 5 clusters were identified which were based on the following parameters: ACS, invasive coronary procedure, cardiac disease (i.e., hypertensive cardiac disease, cardiomyopathy, aortic aneurysm, cardiac valve disease), exclusion of CHD. There were significant differences between the five patient clusters: percentages of patients with diabetes, renal insufficiency and CHF varied between 14.1 and 32.9 %, 9.5 and 31.6 %, and 7.0 and 16.9 %, respectively; average duration of hospitalization and death rates varied between 5.5 (without ACS) and 8 days (ACS) and 0.3 and 4.5 %, respectively. The distribution of patient clusters varied significantly between the German federal states as well as within a federal state.

Conclusions

Five patient clusters with CP showed significantly differing profiles of risk, outcome and resource consumption as well as a regional distribution. This has to be considered for comparisons between hospitals as well as on a regional and international level and hospital planning.

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Acknowledgments

The authors thank the Federal Joint Committee that it allowed the evaluation of the data and Mrs. Gale for review of the manuscript.

Conflict of interest

The authors declare that they have no conflict of interests.

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Authors and Affiliations

  1. Institut für klinische Pharmakologie, TU Dresden, Fiedlerstr. 27, 01307, Dresden, Germany

    Kurt Bestehorn

  2. Klinik für Kardiologie-Angiologie, Universitätsklinik Gießen-Marburg, Standort Gießen, 35392, Giessen, Germany

    Timm Bauer & Christian Hamm

  3. Klinik für Innere Medizin, Kardiologie, Deutsches Herzzentrum Berlin, 13353, Berlin, Germany

    Eckart Fleck

  4. ProMedCon GmbH, 82067, Ebenhausen, Germany

    Maike Bestehorn

  5. AQUA Institut für Angewandte Qualitätsförderung und Forschung im Gesundheitswesen, 37073, Göttingen, Germany

    Jürgen Pauletzki

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  1. Kurt Bestehorn
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  2. Timm Bauer
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Correspondence to Kurt Bestehorn.

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Bestehorn, K., Bauer, T., Fleck, E. et al. Coronary procedures in German hospitals: a detailed analysis for specific patient clusters. Clin Res Cardiol 104, 555–565 (2015). https://doi.org/10.1007/s00392-015-0818-3

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  • DOI: https://doi.org/10.1007/s00392-015-0818-3

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