What is the Best Way to Report PCI Outcomes in Era of Mandatory Public Reporting?
With public reporting of outcomes after percutaneous coronary intervention (PCI) likely to be made standard practice, classification of deaths as PCI-related and non PCI-related may be a better marker of operator performance and quality of procedure than the traditional use of death certificates, according to a study published in the Journal of the American College of Cardiology.
"Public reporting of 30-day mortality after PCI without clearly identifying the cause may result in operator risk avoidance and impact hospital reputation and reimbursements," the study authors note. "Death certificates, utilized by previous reports, have poor correlation with actual cause of death and may be inadequate for public reporting."
According to the study, which was based on a detailed chart review of 4,078 patients undergoing PCI at a single tertiary care center between January 2009 and April 2011, 81 patients died (2 percent) within 30 days. Of these, 58 percent died of cardiac-related causes, compared to 42 percent that died of non-cardiac causes. Less than half of the 30-day deaths (42 percent) were attributed to PCI-related complications. The authors note that compared to PCI-related deaths, those patients with non PCI-related death presented with a higher incidence of cardiogenic shock (15/47 (32%) versus 2/34 (6%); p < 0.01) and cardiac arrest (19/47 (40%) versus 1/34 (3%); p < 0.01). In addition, a poor correlation between cause of death determined by chart review and that reported by death certificates was observed, with death certificates demonstrating only 58 percent accuracy when it came to classifying deaths as cardiac versus non-cardiac.
Based on the data, the authors stress the importance of classifying causes of death into categories that "truly reflect a physician and an institution's competence" and act as an indicator of performance. "We propose classifying post PCI deaths as PCI or non PCI-related which better represents quality of PCI and operator performance," they note. "Death certificates have limitations and are not ideal for public health reporting."
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