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The appropriateness of use of coronary angiography in Lebanon: Implications for health policy

Show simple item record Sibai A.M. Tohme R.A. Saade G.A. Ghanem G. Alam S.
dc.contributor.editor May-2008 2017-10-05T15:40:51Z 2017-10-05T15:40:51Z 2008
dc.identifier 10.1093/heapol/czn005
dc.identifier.issn 02681080
dc.description.abstract Background: Lebanon, characterized by a free-market health care system, has one of the highest reported per capita rates of cardiac catheterization facilities and coronary angiographies in the world. The aim of this study is to evaluate the appropriateness of performance of coronary angiography procedures in Lebanon. Methods: Data derived from the 2004 Lebanese Interventional Coronary Registry (LICOR) included 5418 patients aged 30 years and older who had not undergone prior percutaneous coronary intervention or coronary artery bypass grafting. Appropriateness was evaluated based on the Class I indications of the ACC-AHA guidelines for coronary angiography. Findings: The overall rate of appropriate procedures was 54.7percent (95percent CI 53.3-56.0percent). Appropriateness varied significantly by gender and across administrative regions. Compared with females, males were more likely to be referred appropriately for coronary angiography (OR = 1.28, 95percent CI = 1.15-1.44). Appropriateness was lowest (OR = 0.89, 95percent CI = 0.71-1.12) in the region where the per capita density of cardiac catheterization labs increased by six-fold in the latter 2 years. The majority of the patients (84.3percent) were not evaluated by any of the non-invasive tests prior to angiography, with only 10.8percent, 4percent and 1.5percent of the patients referred for an exercise stress test, stress echocardiography and thallium stress tests, respectively. Discussion: Findings indicate a high rate of procedures conducted without appropriate indications and a low utilization rate of pre-interventional non-invasive testing. This may be attributed to three factors: a surplus of catheterization facilities in certain regions, the insignificant cost gradient between non-invasive testing and coronary angiography, and the wide case-based reimbursement of coronary angiography, unlike non-invasive testing, by public insurance schemes. © The Author 2008; all rights reserved.
dc.format.extent Pages: (210-217)
dc.language English
dc.publisher OXFORD
dc.relation.ispartof Publication Name: Health Policy and Planning; Publication Year: 2008; Volume: 23; no. 3; Pages: (210-217);
dc.source Scopus
dc.title The appropriateness of use of coronary angiography in Lebanon: Implications for health policy
dc.type Article
dc.contributor.affiliation Sibai, A.M., Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon
dc.contributor.affiliation Tohme, R.A., Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon, Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, PO Box: 11-0236, Riad El Solh 1107, 2020 Beirut, Lebanon
dc.contributor.affiliation Saade, G.A., Lebanese Society of Cardiology
dc.contributor.affiliation Ghanem, G., Lebanese Society of Cardiology, Rizk Hospital, Beirut, Lebanon
dc.contributor.affiliation Alam, S., Department of Internal Medicine, Cardiology Division, American University of Beirut Medical Center, Lebanon
dc.contributor.authorAddress Tohme, R. A.; Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, PO Box: 11-0236, Riad El Solh 1107, 2020 Beirut, Lebanon; email:
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Internal Medicine; Division: Cardiology;
dc.contributor.authorDepartment Internal Medicine
dc.contributor.authorDivision Cardiology
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorInitials Sibai, AM
dc.contributor.authorInitials Tohme, RA
dc.contributor.authorInitials Saade, GA
dc.contributor.authorInitials Ghanem, G
dc.contributor.authorInitials Alam, S
dc.contributor.authorReprintAddress Tohme, RA (reprint author), Amer Univ Beirut, Fac Hlth Sci, Dept Epidemiol and Populat Hlth, POB 11-0236,Riad Solh 1107, Beirut 2020, Lebanon.
dc.contributor.authorUniversity American University of Beirut Medical Center
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dc.description.citedCount 5
dc.description.citedTotWOSCount 7
dc.description.citedWOSCount 6
dc.format.extentCount 8
dc.identifier.coden HPOPE
dc.identifier.pubmedID 18356190
dc.identifier.scopusID 45949101455
dc.relation.ispartOfISOAbbr Health Policy Plan.
dc.relation.ispartOfIssue 3
dc.relation.ispartofPubTitle Health Policy and Planning
dc.relation.ispartofPubTitleAbbr Health Policy Plann.
dc.relation.ispartOfVolume 23
dc.source.ID WOS:000255151200006
dc.type.publication Journal
dc.subject.otherAuthKeyword Appropriateness
dc.subject.otherAuthKeyword Cardiovascular diseases
dc.subject.otherAuthKeyword Coronary angiography
dc.subject.otherAuthKeyword Lebanon
dc.subject.otherAuthKeyword Medical technology
dc.subject.otherIndex angiocardiography
dc.subject.otherIndex article
dc.subject.otherIndex clinical practice
dc.subject.otherIndex coronary artery bypass graft
dc.subject.otherIndex exercise test
dc.subject.otherIndex health care policy
dc.subject.otherIndex human
dc.subject.otherIndex Lebanon
dc.subject.otherIndex percutaneous coronary intervention
dc.subject.otherIndex practice guideline
dc.subject.otherIndex stress echocardiography
dc.subject.otherIndex adult
dc.subject.otherIndex aged
dc.subject.otherIndex female
dc.subject.otherIndex health care policy
dc.subject.otherIndex interview
dc.subject.otherIndex male
dc.subject.otherIndex middle aged
dc.subject.otherIndex register
dc.subject.otherIndex unnecessary procedure
dc.subject.otherIndex utilization review
dc.subject.otherIndex Adult
dc.subject.otherIndex Aged
dc.subject.otherIndex Coronary Angiography
dc.subject.otherIndex Female
dc.subject.otherIndex Health Policy
dc.subject.otherIndex Humans
dc.subject.otherIndex Interviews as Topic
dc.subject.otherIndex Lebanon
dc.subject.otherIndex Male
dc.subject.otherIndex Middle Aged
dc.subject.otherIndex Registries
dc.subject.otherIndex Unnecessary Procedures
dc.subject.otherKeywordPlus NEW-YORK-STATE
dc.subject.otherKeywordPlus ASSOCIATION TASK-FORCE
dc.subject.otherKeywordPlus BYPASS GRAFT-SURGERY
dc.subject.otherKeywordPlus EURO HEART SURVEY
dc.subject.otherKeywordPlus CHEST-PAIN
dc.subject.otherKeywordPlus INTERVENTIONAL CARDIOLOGY
dc.subject.otherKeywordPlus MYOCARDIAL-INFARCTION
dc.subject.otherKeywordPlus ARTERY-DISEASE
dc.subject.otherKeywordPlus REVASCULARIZATION
dc.subject.otherWOS Health Care Sciences and Services
dc.subject.otherWOS Health Policy and Services

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