Key result
FFR guides stenting decisions more frequently than IVUS, with ~73% of operators reporting its use.
Cross-Sectional (n=255)
Yes
Absolute Event Rate: 73% vs 60%
p-value: p=<0.01
Despite guideline recommendations, FFR is underutilized by interventionalists primarily due to lack of availability and reimbursement issues.
FFR underutilization persists despite guidelines; leaves open whether reimbursement and availability interventions would increase adoption.
Major medical society guidelines recommend the measurement of fractional flow reserve (FFR) as an aid in choosing percutaneous coronary intervention in patients with stable coronary artery disease. We investigated the measurement of FFR among interventionalists, analyzing operators' attributes and decision-making processes to reveal differences in their applications of FFR and the reasons for those differences. An electronic survey study of 1,089 interventionalists was performed from 2 February through 6 March 2012, yielding 255 responses. Most respondents were >45 years old (58%), worked primarily in a community hospital (59%), and performed 10 to 30 cases per month (52%). More than half (145/253, 57%) used FFR measurement in less than one third of cases, and 39 of 253 (15%) never used it. There were no differences in use of FFR by age, practice location, or angiogram volume (P >0.05 for all). Respondents used FFR measurement more frequently than intravascular ultrasonography (73% vs 60%) to help guide the decision to stent (P <0.01). Operators reported that their primary reasons for not using FFR were lack of availability (47%) and problems with reimbursement (39%). There was no difference in FFR use by operator age, practice setting, or case volume.
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Hannawi et al. (2014) conducted a cross-sectional in Coronary artery disease (interventionalists' practice) (n=255). Fractional flow reserve (FFR) measurement vs. Intravascular ultrasonography (IVUS) was evaluated on Use to help guide the decision to stent (p=<0.01). Fractional flow reserve measurement was used more frequently than intravascular ultrasonography to guide stenting decisions (73% vs 60%, P<0.01), though 57% used it in less than one third of cases.
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