Original Investigation
Association Between Public Reporting of Outcomes With Procedural Management and Mortality for Patients With Acute Myocardial Infarction

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Abstract

Background

Public reporting of procedural outcomes may create disincentives to provide percutaneous coronary intervention (PCI) for critically ill patients.

Objectives

This study evaluated the association between public reporting with procedural management and outcomes among patients with acute myocardial infarction (AMI).

Methods

Using the Nationwide Inpatient Sample, we identified all patients with a primary diagnosis of AMI in states with public reporting (Massachusetts and New York) and regionally comparable states without public reporting (Connecticut, Maine, Maryland, New Hampshire, Rhode Island, and Vermont) between 2005 and 2011. Procedural management and in-hospital outcomes were stratified by public reporting.

Results

Among 84,121 patients hospitalized with AMI, 57,629 (69%) underwent treatment in a public reporting state. After multivariate adjustment, percutaneous revascularization was performed less often in public reporting states than in nonreporting states (odds ratio [OR]: 0.81, 95% confidence interval [CI]: 0.67 to 0.96), especially among older patients (OR: 0.75, 95% CI: 0.62 to 0.91), those with Medicare insurance (OR: 0.75, 95% CI: 0.62 to 0.91), and those presenting with ST-segment elevation myocardial infarction (OR: 0.63, 95% CI: 0.56 to 0.71) or concomitant cardiac arrest or cardiogenic shock (OR: 0.58, 95% CI: 0.47 to 0.70). Overall, patients with AMI in public reporting states had higher adjusted in-hospital mortality rates (OR: 1.21, 95% CI: 1.06 to 1.37) than those in nonreporting states. This was observed predominantly in patients who did not receive percutaneous revascularization in public reporting states (adjusted OR: 1.30, 95% CI: 1.13 to 1.50), whereas those undergoing the procedure had lower mortality (OR: 0.71, 95% CI: 0.62 to 0.83).

Conclusions

Public reporting is associated with reduced percutaneous revascularization and increased in-hospital mortality among patients with AMI, particularly among patients not selected for PCI.

Key Words

acute coronary syndromes(s)
percutaneous coronary intervention
public reporting

Abbreviations and Acronyms

AMI
acute myocardial infarction
CI
confidence interval
ICID-9-CM
International Classification of Diseases-Ninth Revision-Clinical Modification
IQR
interquartile range
NIS
nationwide inpatient sample
NSTEMI
non–ST-segment elevation myocardial infarction
OR
odds ratio
PCI
percutaneous coronary intervention
STEMI
ST-segment elevation myocardial infarction

Cited by (0)

The study was supported by the Hassenfeld Scholars Program. Dr. Yeh was supported by National Heart, Lung, and Blood Institute career development award 1K23HL118138. Dr. McCabe receives speaking honoraria from Abbott Vascular and Edwards LifeSciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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