Study Looks at Public Reporting of Outcomes in AMI Patients

Public reporting may have unfavorable outcomes in critically ill, acute myocardial infarction (AMI) patients, according to a study published March 16 in the Journal of the American College of Cardiology.

Study author Stephen W. Waldo, MD, and his team used the Nationwide Impatient Sample to study procedural management and outcomes in all patients with primary AMI from 2005 to 2011. Patient outcomes in states with public reporting (New York and Massachusetts) were contrasted against results in regionally comparable states that did not have public reporting (Connecticut, Maine, Maryland, New Hampshire, Rhode Island and Vermont).

After multivariate adjustments, results demonstrated a great correlation between public reporting and reduced percutaneous revascularization (odds ratio [OR]: 0.81, 95 percent confidence interval [CI]: 0.67 to 0.96) and greater in-hospital mortality in AMI patients, especially in those who did not receive percutaneous coronary intervention (PCI).

“Patients treated in a public reporting state are less likely to undergo percutaneous revascularization, particularly when they have high-risk features such as older age, cardiogenic shock, cardiac arrest, or STEMI,” said Waldo. “These data suggest that public reporting may improve PCI-related outcomes but may also have the unintended consequence of increasing risk aversion to the detriment of overall outcomes for patients with myocardial infarction.”

The authors conclude that moving forward, “public reporting of outcomes should balance the benefits of transparency and accountability against the potential influence of physician risk aversion.”

In a related editorial comment, Mauro Moscucci, MD, MBA, FACC, notes, “there is no question that collection of outcome data can foster successful quality improvement efforts, and it can identify ‘statistically significant’ variations in outcomes that might require external interventions or at least an explanation … The answer is not to avoid participation in national or regional registries that provide valuable benchmarks and comparative data. Rather, we should continue to refine our risk adjustment methodologies, educate the public on how to interpret available data, and continue to engage the interventional cardiology community in regional or national continuous quality assurance and quality improvement programs.”

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

Keywords: Critical Illness, Heart Arrest, Hospital Mortality, Myocardial Infarction, Percutaneous Coronary Intervention, Quality Improvement, Registries, Risk Adjustment, Shock, Cardiogenic

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