Do responses to news matter? Evidence from interventional cardiology

We examine physician responses to a global information shock and how these impact their patients. We exploit international news over the safety of an innovation in healthcare, the drug-eluting stent. We use data on interventional cardiologists' use of stents to define and measure cardiologists' responsiveness to the initial positive news and link this to their patients' outcomes. We find substantial heterogeneity in responsiveness to news. Patients treated by cardiologists who respond slowly to the initial positive news have fewer adverse outcomes. This is not due to patient-physician sorting. Instead, our results suggest that the differences are partially driven by slow responders being better at deciding when (not) to use the new technology, which in turn affects their patient outcomes

The risk of restenosis at 1 year after PCI in relation to stent inflation pressure (panel A).

<p>Estimated cumulative event rates of restenosis in relation to stent inflation pressure (panel B).</p

The risk of death at 1 year after PCI in relation to stent inflation pressure (panel A).

<p>Estimated cumulative event rates of death in relation to stent inflation pressure (panel B).</p

Estimated cumulative event rates of stent thrombosis in relation to post-dilatation (panel A).

<p>The RR of stent thrombosis of 1.18 (CI 0.95–1.32) did not differ statistically between procedures with or without post-dilatation (P = 0.19). Estimated cumulative event rates of restenosis in relation to post-dilatation (panel B). Restenosis occurred more often following post-dilatation compared with procedures where this adjunct was not used (RR 1.22 (CI 1.14–1.32) P<0.001). Estimated cumulative event rates of death in relation to post-dilatation (Panel C). The risk of death was lower following post-dilatation (RR 0.81 (CI 0.71–0.93) P = 0.003). The numbers at risk are for stent thrombosis and restenosis are identical to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056348#pone-0056348-g001" target="_blank">Figure 1</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056348#pone-0056348-g002" target="_blank">2</a> while the numbers at risk for death are identical to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0056348#pone-0056348-g003" target="_blank">Figure 3</a>.</p

Radiation dose distribution in coronary arteries in breast cancer radiotherapy

<p><b>Background:</b> Women irradiated for left-sided breast cancer (BC) have an increased risk of coronary artery disease compared to women with right-sided BC. We describe the distribution of radiation dose in segments of coronary arteries in women receiving adjuvant radiotherapy (RT) for left- or right-sided BC.</p> <p><b>Material and methods:</b> Fifteen women with BC, seven left-sided and eight right-sided, who had received three-dimensional conformal radiotherapy (3DCRT), constituted the study base. The heart and the segments of the coronary arteries were defined as separate organs at risk (OAR), and the mean and maximum radiation doses were calculated for each OAR.</p> <p><b>Results:</b> In women with left-sided BC, irrespective of if regional lymph node RT was given or not, maximum dose in mid and distal left anterior descending artery (mdLAD) was approximately 50 Gy in 6/7 patients, whereas women with right-sided BC mainly received low doses of radiation. In women with left-sided BC, 6/7 patients had substantially higher mean dose to the distal LAD than to the heart, ranging from 30 to 55 Gy and 3 to13 Gy, respectively.</p> <p><b>Conclusion:</b> We found a pronounced difference of radiation dose distribution in the coronary arteries between women with left- and right-sided BC. Women with left-sided BC had almost full treatment dose in parts of mdLAD, regardless of if regional lymph node irradiation was given or not, while women with right-sided BC mainly received low doses to the coronary arteries.</p

Flow chart for identification and selection of CTO patients in SCAAR.

<p>Based on the selection methods we have defined two CTO groups. The first group - <i>the total CTO cohort-</i> contains all CTO patients recognized by one or both methods during the period. The second group is the subcohort that contains the patients in whom a CTO was identified through the %-luminal stenosis on the coronary segments – <i>the coronary segment subcohort</i>.</p

Baseline characteristics of CTO patients from coronary segment subcohort according to the treatment strategy.

<p>CAD: coronary artery disease, CCS: Canadian cardiovascular society, CTO: chronic total occlusion, IQR: inter quartile range, MI: myocardial infarction, (N)STEMI: (non-)ST-elevation myocardial infarction, PCI: percutaneous coronary intervention.</p><p>* Cardiogenic shock only displayed for the indication STEMI.</p><p>**CCS class only displayed for the indication stable CAD.</p><p>*** Left main (LM) disease includes: LM+1 vessel, LM+2 vessel and LM+3 vessel.</p><p>Data about initial treatment strategy were missing in four CTO patients.</p

Annual number of coronary angiographies, PCI's, and PCI's performed in CTO patients in Sweden reported in SCAAR since 1999.

<p>Annual number of coronary angiographies, PCI's, and PCI's performed in CTO patients in Sweden reported in SCAAR since 1999.</p

Baseline characteristics of the total CTO cohort in SCAAR at the time of diagnosis based on data collected during the period 2005–2012.

<p>CAD: coronary artery disease, CCS: Canadian cardiovascular society, CTO: chronic total occlusion, IQR: inter quartile range, MI: myocardial infarction, (N)STEMI: (non-)ST-elevation myocardial infarction, PCI: percutaneous coronary intervention.</p><p>* Cardiogenic shock only displayed for the indication STEMI.</p><p>**CCS class only displayed for the indication stable CAD.</p><p>*** Left main (LM) disease includes: LM+1 vessel, LM+2 vessel and LM+3 vessel.</p

Baseline characteristics of patients from coronary segment subcohort with coronary artery disease, stratified for the presence of a CTO observed on angiography.

<p>CAD: coronary artery disease, CCS: Canadian cardiovascular society, CTO: chronic total occlusion, IQR: inter quartile range, MI: myocardial infarction, (N)STEMI: (non-)ST-elevation myocardial infarction, PCI: percutaneous coronary intervention.</p><p>* Cardiogenic shock only displayed for the indication STEMI.</p><p>**CCS class only displayed for the indication stable CAD.</p><p>*** Left main (LM) disease includes: LM+1 vessel, LM+2 vessel and LM+3 vessel.</p