Poor physician compliance with guidelines for IVC filter placement, says study


A recent New York-based study published in the Journal of Vascular and Interventional Radiology (JVIR) has found that there is poor physician compliance with guidelines for inferior vena cava filter placement. The single-centre study also calls for ironing out the current discrepancies between guidelines advocated by professional societies.

Authors of the study, Amanjit S Baadh, New York, USA and colleagues, report that inferior vena cava filter placement had increased significantly over the past few decades. However, indications for filter placement differed widely depending on which professional society’s recommendations are followed, they wrote. They also clarified that it was uncertain how compliant physicians are in adhering to guidelines pertaining to the use of filter placement. The study in question assessed documented indications for inferior vena cava filter placement and evaluated compliance with standards set by the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR).

Baadh et al designed a single-centre, retrospective medical record review in a metropolitan, 652-bed, acute care, teaching hospital and reviewed the inpatient filter placement a little over a two-year period. The investigators also evaluated compliance with established guidelines, noted the relationship of medical specialty to filter placement, and looked at the self-referral patterns among physicians.

The researchers found that compliance with established ACCP guidelines was poor regardless of whether the filter insertion was performed by interventional radiology (43.5%), vascular surgery (39.9%), or interventional cardiology (33.3%) staff.  They also found that compliance with the less restrictive SIR guidelines was better (77.5%, for interventional radiology, 77.1% for vascular surgery and 80% for interventional cardiology). Results of the study showed that there was a greater degree of guideline compliance when filter placement was recommended by internal medicine–trained physicians than by non–internal medicine-trained physicians: 46.3% of interventional radiology-placed filters requested by internal medicine physicians met ACCP criteria whereas only 24% of filters recommended by non-internal medicine specialties were compliant with criteria (p=0.03). In the vascular surgery group, these compliance rates were 45.8% and 31.5%, respectively (p=0.03). Among interventional radiology-placed filters, 84% of internal medicine-recommended filter placements were compliant with SIR guidelines, vs only 48% of non-internal medicine recommended placements (p≤ 0.001). In the vascular surgery group, these compliance rates were 87.8% and 69.6%, respectively (p≤ 0.001).

“Most filter indications meeting SIR guidelines are for patients classified as “falls risks,” failures of anticoagulation, patients with limited cardiopulmonary reserve and patients non compliant with anticoagulation medications. This single-centre study suggests a need for harmonisation of current guidelines espoused by professional societies,” they wrote.