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Public reporting of PCI outcomes lowered use, failed to affect mortality
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The use of PCI was lower for patients treated in states with public reporting of outcomes after the procedure compared with patients in states without it, although no difference was observed in overall acute MI mortality, according to recent data.
Karen E. Joynt, MD, MPH, with Brigham and Women’s Hospital and VA Boston Healthcare System, and fellow investigators created a retrospective, observational study of fee-for-service Medicare patients admitted with acute MI from 2002 to 2010 in states that publically report outcomes (New York, Massachusetts and Pennsylvania) compared with control states in New England and the Mid-Atlantic region that do not report outcomes (Maine, Vermont, New Hampshire, Connecticut, Rhode Island, Maryland and Delaware).
Patients with acute MI were less likely to receive PCI in public reporting states than in nonreporting states (unadjusted rates, 37.7% vs. 42.7%; risk-adjusted OR=0.82; 95% CI, 0.71-0.93). Differences were greatest among patients with STEMI (61.8% vs. 68%; OR=0.73; 95% CI, 0.59-0.89) and cardiogenic shock or cardiac arrest (41.5% vs. 46.7%; OR=0.79; 95% CI, 0.64-0.98).
However, there were no differences in overall mortality among patients with acute MI in reporting states compared with nonreporting states.
Karen E. Joynt
Joynt and colleagues also considered changes in PCI rates over time in Massachusetts before and after the state began public reporting in 2005. Odds of PCI for acute MI were comparable with odds in nonreporting states before public reporting (40.6% vs. 41.8%; OR=1.00; 95% CI, 0.71-1.41). However, after implementation of public reporting, odds of undergoing PCI in Massachusetts decreased compared with nonreporting states (41.1% vs. 45.6%; OR=0.81; 95% CI, 0.47-1.38). The difference was most marked for cardiogenic shock or cardiac arrest compared with nonreporting states (pre-reporting: 44.2% vs. 36.6%; OR=1.40; 95% CI, 0.85-2.32; post-reporting: 43.9% vs. 44.8%; OR=0.92; 95% CI, 0.38-2.22).
In an accompanying editorial, Mauro Moscucci, MD, MBA, with the University of Miami Miller School of Medicine, observed that possible denial of care in patients with acute MI and cardiogenic shock — given the known benefit of PCI — could have a chilling effect.
“However, the similar 30-day mortality rates in public reporting and nonreporting states mitigate this concern,” he wrote.
For more information:
Joynt K. JAMA. 2012;308:1460-1468.
Moscucci M. JAMA. 2012;308:1478-1479.