Cleve Clin J Med 2018 Feb;85(2):105-121
Vice-Chair for Research, Medicine Institute, and Director, Center for Value-Based Care Research, Cleveland Clinic, Cleveland, OH, USA.
Download full-text PDF
JAMA Intern Med 2015 Jul;175(7):1199-206
Health Decision Sciences, Massachusetts General Hospital, Harvard Medical School, Boston.
Importance: Patients with stable coronary disease undergoing percutaneous coronary intervention (PCI) are frequently misinformed about the benefits of PCI. Little is known about the quality of decision making before angiography and possible PCI.
Objective: To assess the quality of informed decision making and its association with patient decisions. Read More
JAMA Intern Med 2014 Oct;174(10):1614-21
Department of Internal Medicine, Cleveland Clinic Medicine Institute, Cleveland, Ohio.
Importance: Patients with stable coronary artery disease (CAD) attribute greater benefit to percutaneous coronary interventions (PCI) than indicated in clinical trials. Little is known about how cardiologists' presentation of the benefits and risks may influence patients' perceptions.
Objectives: To broadly describe the content of discussions between patients and cardiologists regarding angiogram and PCI for stable CAD, and to describe elements that may affect patients' understanding. Read More
Popul Health Manag 2013 Jun 31;16(3):164-8. Epub 2012 Oct 31.
OptumHealth Care Solutions, Fort Myers, FL 33967, USA.
Overutilization, defined as use of unnecessary care when alternatives may produce similar outcomes, results in higher cost without increased value. Overutilization can be understood by focusing on settings where overuse is obvious. One example is percutaneous coronary intervention (PCI) in chronic stable angina. Read More
Rev Prat 2015 Mar;65(3):352-6
Percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) must be considered among stable angina pectoris patients who remained symptomatic despite optimal medical treatment and to improve prognosis of patients with large myocardial lschemia when occurring at low workload. PCI is preferred for single coronary artery stenosis, while CABG is recommended for severe multivessel disease patients, particularly when diabetes is present. There is no simple decisional algorithm, and, for patients with multivessel disease, each situation must be debated within a multidisciplinary decision-making team (Heart Team), taking into consideration risks and benefits of PCI vs CABG, patients' comorbidities and local experience. Read More