The Impact of Public Reporting for Cardiogenic Shock
- An investigative study sought to examine the effect of excluding cardiogenic shock from public reporting and its impact on referring patients for guideline-directed care.
- There was a 19% increase in the use of PCI for cardiogenic shock patients in New York after the exclusion of cardiogenic shock from public reporting.
In New York state, public reporting of mortality following PCI and coronary artery bypass grafting (CABG) has been in effect since the late 1980s and early 1990s.2 This publicly available data has significantly affected interventionalists’ decisions on whether to perform PCI. In fact, close to 80% of cardiologists interviewed by the University of Rochester said public reporting impacted their choice of revascularization procedure. Subsequently, patients in New York state are often less likely to undergo CABG and PCI compared with other states.
Can Excluding Cardiogenic Shock from Public Reporting Increase Surgical Referrals?
An investigative study published in JAMA Cardiology sought to examine the effect of excluding cardiogenic shock from public reporting and its impact on referring patients for guideline-directed care (PCI, CABG, or cardiac catheterization).3
This analysis included patients with cardiogenic shock complicating acute MI between 2002 and 2011 across four states: California, Michigan, New Jersey, and New York. The primary outcome was the amount of patients undergoing PCI prior to and following the exclusion of cardiogenic shock from publicly available outcomes data. The proportion of patients who underwent the following interventions were also included:
- Invasive Management
- Cardiac catheterization
According to the findings, there was a 19% increase in the use of PCI for cardiogenic shock patients in New York after the exclusion of cardiogenic shock from public reporting. Similar increases were found with the use of invasive management and revascularization (18% and 23%, respectively) for New York patients; however, there was no significant increase in CABG following exclusion of cardiogenic shock from public reporting.
This study found that when cardiogenic shock was excluded from publicly available cardiovascular data, more patients underwent invasive treatment for cardiogenic shock complicating MI.
- Santora M. Cardiologists Say Rankings Affect Surgical Decisions. New York Times. January 11, 2005. http://query.nytimes.com/gst/fullpage.html?res=9F00E0DA1F39F932A25752C0A9639C8B63. Accessed December 6, 2016.
- Hannan EL, Cozzens K, King SB, Walford G, Shah NR. The New York State cardiac registries: history, contributions, limitations, and lessons for future efforts to assess and publicly report healthcare outcomes. J Am Coll Cardiol. 2012;59(25):2309-2316.
- Bangalore S, Guo Y, Xu J, et al. Rates of Invasive Management of Cardiogenic Shock in New York Before and After Exclusion From Public Reporting. JAMA Cardiol. 2016;1(6):640-647.
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