Cardiologists are speaking out against a Lown Institute report that alleged 1 in 5 stents placed in Medicare recipients were considered "overuse," Medscape reported Dec. 20.
The October report looked at percutaneous coronary interventions using Medicare claims data from 2019 to 2021 at 1,773 hospitals with the capacity to perform the procedure. The stent placement was defined as "overuse" if it was in a patient with stable coronary artery disease. It concluded more than 229,000, or 20%, of stent placements were unnecessary.
However, cardiologists said the Lown criteria for overuse ignored the appropriate use criteria and other guidelines published by professional societies.
"Their invented, new definition of overuse is something that belongs to them," George Dangas, MD, PhD, president of the Society for Cardiovascular Angiography and Interventions and professor of medicine and surgery at Icahn School of Medicine at Mount Sinai in New York City, told Medscape. The overuse definition "doesn't have validity or generalizable utilization by anyone except for themselves," he said.
Wayne Batchelor, MD, chair of the Interventional Council at the American College of Cardiology, told Medscape Lown "used an extremely liberal definition of overuse" and noted it covered any stent placed during a nonemergency.
"It's just not consistent with reality, nor does it take into account the multiple factors that go into decision-making for implanting stents that patients and physicians must take into account," he said.
The Lown Institute countered that its calculations have been published and its methodology for the report is based in part on a 2014 investigation a JAMA on low-value care in Medicare and a 2021 paper on overuse of medical tests. The Institute explained its methods in a 2023 white paper.