Should PCI Outcomes For Cardiac Arrest or Cardiogenic Shock be Publically Reported?

Public reporting of percutaneous coronary intervention (PCI) outcomes in patients with cardiac arrest or cardiogenic shock may be unfair to interventionalists and may lead to worse outcomes, according to a council perspective on behalf of ACC’s Interventional Council and ACC’s Board of Governors published March 7 in JACC: Cardiovascular Interventions.

Syed Tanveer Rab, MD, FACC, member of ACC’s Interventional Section Leadership Council, and B. Hadley Wilson, MD, FACC, president of the ACC North Carolina Chapter, write that public reporting of death after PCI places blame on the hospital or interventionalists, but mortality is usually the result of neurological complications or multiorgan failure despite receiving optimal care. Additionally, they are concerned that public reporting and “pay for performance” may lead to risk-adverse behavior that may in turn lead to negative consequences for patients. PCI may be withheld from the patients who are sickest and may see the biggest benefit from the procedure, because doctors or hospitals are worried about their own quality metrics or reported outcomes. Additionally, they explain that there is evidence to support the claim that public reporting has led to worse PCI outcomes.

Peter B. Berger, MD, FACC, an editorial consultant for JACC: Cardiovascular Interventions, responds to these concerns in an Editor’s Page. While he agrees with some of the points Rab and Wilson make – that there are limited data that public reporting improves outcomes and that physicians avoid PCI in high-risk patients – he disagrees that PCI outcomes should not be reported. He writes that the public insists on medical data being reported and that risk-adverse behavior is common everywhere, not just in states with public reporting. He adds that physicians or hospitals that withhold PCI from high-risk patients out of fear of the consequences should be educated and this behavior should be publicly reported.

He cautions that, “When data are not publicly reported, journalists and others are able to petition for such data under the  Freedom of Information Act. The data will then end up in the public domain without appropriate risk adjustment. We can all agree that that would be inappropriate. But it is likely that this will occur in the future without public reporting.”

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure

Keywords: Freedom, Heart Arrest, Hospitals, Leadership, Percutaneous Coronary Intervention, Public Sector, Reimbursement, Incentive, Risk Adjustment, Shock, Cardiogenic, Cardiology Magazine

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