{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T07:54:34Z","timestamp":1791618874845,"version":"4.3.4"},"reference-count":42,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) are common procedures for the diagnosis and treatment of coronary artery disease (CAD). These procedures are typically performed within the parameters of insurance coverage, but little is known about how insurance policies align with guidelines and landmark randomized clinical trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We developed 6 use cases (3 each for ICA and PCI) of clinical scenarios for stable CAD commonly encountered in clinical practice and compared policies of the largest US public and private payers (based on total revenue and number of beneficiaries) to the 2012 and 2023 professional society guidelines as well as the ORBITA (Objective Randomized Blinded Investigation With Optimal Medical Therapy of Angioplasty in Stable Angina) and ISCHEMIA (Initial Invasive or Conservative Strategy for Stable Coronary Disease) trials. We classified policies as more restrictive, equal, or less restrictive than the guidelines and published randomized clinical trials by evaluating them on parameters of optimal medical therapy (OMT) and noninvasive imaging for ICA policies; and OMT, anatomic severity of CAD, and ability to proceed with PCI for PCI policies. We summarized findings with descriptive statistics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>Among 33 payers, 18 (55%) ICA and 14 (42%) PCI policies were publicly available. When comparing requirements for OMT among symptomatic patients before ICA, 22% of policies were less restrictive, 75% were equivalent, and 3% were more restrictive than the 2012 and 2023 professional society guidelines. For the number of OMT medications among symptomatic patients before ICA, 44% were less restrictive and 56% were equivalent compared with the ORBITA trial. When comparing requirements for OMT for symptomatic patients before PCI, 21% of policies were less restrictive, 75% were equivalent, and 4% were more restrictive than the 2012 and 2023 guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>ICA and PCI coverage policies were only publicly available for approximately half of the largest US insurers, indicating need for greater transparency. When available, policies were variable in their alignment with clinical practice guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.124.011497","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T09:00:13Z","timestamp":1761210013000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Insurer Coverage of Invasive Coronary Angiography and Percutaneous Coronary Intervention for Stable Coronary Artery Disease in the United States Compared With Guidelines and Landmark Trials"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6040-0693","authenticated-orcid":true,"given":"Allison","family":"Kratka","sequence":"first","affiliation":[{"name":"Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (A.K., S.S.D.)."},{"name":"Division of Cardiology, Department of Medicine (A.K., R.F.R.), University of California, San Francisco School of Medicine."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Medicine (C.G.), University of California, San Francisco School of Medicine."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Guduguntla","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, IL (V.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6281-0250","authenticated-orcid":true,"given":"Rita F.","family":"Redberg","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine (A.K., R.F.R.), University of California, San Francisco School of Medicine."},{"name":"Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (R.F.R., S.S.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0674-2032","authenticated-orcid":true,"given":"Sanket S.","family":"Dhruva","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, San Francisco Veterans Affairs Medical Center, CA (A.K., S.S.D.)."},{"name":"Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco (R.F.R., S.S.D.)."},{"name":"University of California, San Francisco School of Medicine (S.S.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.12.004"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.123.013003"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915922"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa070829"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.122.062714"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0805796"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)32714-9"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001168"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.11.058"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.601"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.01.050"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.13764"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2022.10.002"},{"key":"e_1_3_3_15_2","unstructured":"National Association of Insurance Commissioners. 2022 market share reports for the top 125 accident and health insurance groups and companies by state and countrywide. Accessed June 18 2024. https:\/\/content.naic.org\/sites\/default\/files\/publication-msr-hb-accident-health.pdf"},{"key":"e_1_3_3_16_2","unstructured":"Ochieng N Fuglesten Biniek J Freed M Damico A Neuman T. Medicare Advantage in 2023: enrollment update and key trends. Accessed June 28 2024. https:\/\/www.kff.org\/medicare\/issue-brief\/medicare-advantage-in-2023-enrollment-update-and-key-trends\/"},{"key":"e_1_3_3_17_2","unstructured":"LCD\u2014percutaneous coronary interventions (L34761). Accessed June 28 2024. https:\/\/www.cms.gov\/medicare-coverage-database\/view\/lcd.aspx?lcdId=34761&ver=32"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.916"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.111.964320"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.01.235"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.02.001"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318277d6a0"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001039"},{"key":"e_1_3_3_24_2","unstructured":"SCAI. Point-of-Care App. Accessed September 17 2024. https:\/\/scai.org\/clinical-practice\/quality-improvement\/point-care-app"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2010.12.019"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/HCQ.0000000000000105"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacep.2020.04.022"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2019.7142"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.12.025"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1111\/1468-0009.12595"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2025.3898"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/clc.22594"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.006564"},{"key":"e_1_3_3_34_2","unstructured":"American College of Cardiology. Barriers to new medications for cardiovascular disease: insights from CardioSurve. Accessed June 18 2024. https:\/\/www.acc.org\/latest-in-cardiology\/articles\/2017\/02\/21\/12\/42\/http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2017%2f02%2f21%2f12%2f42%2fbarriers-to-new-medications-for-cardiovascular-disease-insights-from-cardiosurve"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.1193"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.16326"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.5124"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.5967"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.3328"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.006461"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.108.798462"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.110.940502"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae177"}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.124.011497","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T19:00:15Z","timestamp":1763492415000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.124.011497"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11]]},"references-count":42,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.124.011497"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.124.011497","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"value":"1941-7713","type":"print"},{"value":"1941-7705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11]]},"assertion":[{"value":"2024-08-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-23","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}