To the Editor.
—We were most interested in the recent article by Ms Bengtson and colleagues1 that reported that about 90% of coronary angiographies and coronary artery bypass graft (CABG) surgeries performed in southwestern Sweden were judged appropriate and about 2% inappropriate. They concluded that "the percentage of these patients [ie, referred for inappropriate or uncertain indications] is similar to the percentage recently reported from New York State." A review of the methods used, however, raises several additional questions.First, although their appropriateness criteria are well described, the method by which these criteria were established is not addressed. Are these criteria applicable and generalizable within Sweden? Comparing their criteria with those established by a multispecialty national Swedish expert panel2 shows their criteria to be, in general, more liberal (ie, judging more cases to be appropriate). Without knowing the specific clinical details for each case, it is difficult to
Bernstein SJ. The Appropriateness of Coronary Procedures in Sweden. JAMA. 1994;272(16):1254-1255. doi:10.1001/jama.1994.03520160038034