The underuse of carotid interventions in veterans with symptomatic carotid stenosis.

Keyhani S, Cheng E, Ofner S, Williams L, Bravata D. The underuse of carotid interventions in veterans with symptomatic carotid stenosis. The American journal of managed care. 2014 Jul 1; 20(7):e250-6.

Related HSR&D Project(s)

• RRP 09-184 – Stroke Care Quality within the Veterans Health Administration System
• RRP 08-242 – Identifying Veterans at High-Risk for a first-time Stroke

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

If you have VA-Intranet access, click here for more information vaww.hsrd.research.va.gov/dimensions/

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.    Search Dimensions for VA for this citation
* Don't have VA-internal network access or a VA email address? Try searching the free-to-the-public version of Dimensions

Search for Abstract from PubMed

---

Abstract:

OBJECTIVES: To examine the receipt of carotid intervention among eligible patients post stroke in the Veterans Health Administration (VA). METHODS: We examined whether veterans admitted to a VA medical center in 2007 with a diagnosis of stroke and who were eligible for intervention, received carotid intervention in a period up to 6 months after their index hospitalization. We also examined whether demographics, comorbid conditions, stroke severity and availability of vascular intervention services were independently associated with receipt of intervention. RESULTS: Among the 5721 patients admitted, 253 ischemic stroke patients had evidence of some carotid stenosis and had data on side of stroke available. Among the 200 patients who had at least 50% to 99% stenosis of the carotid artery, 34 (17%) received intervention (95% confidence interval [CI], 11.79%-22.21%). In a multivariable model, black race and past history of diabetes were significantly associated with carotid intervention: An eligible black patient was 6 times more likely to NOT receive intervention compared to patients of other races (adjusted odds ratio [OR] = 6.54; 95% CI, 1.34-31.9), and a patient with diabetes was 3 times more likely to NOT receive intervention (adjusted OR = 3.38; 95% CI, 1.24- 9.24) compared to non-diabetics. Stroke severity and availability of vascular surgery services was not associated with receipt of intervention. CONCLUSIONS: Few patients with symptomatic carotid stenosis who were admitted with stroke to the VA received carotid intervention. Future research should be directed at improving access to this procedure among eligible patients in the VA.