Ashwin S Nathan1,2,3, Rohan M Shah4, Sameed A Khatana1,2,3, Elias Dayoub2,3, Paula Chatterjee2,5, Nimesh D Desai2,3,6, Stephen W Waldo7, Robert W Yeh8, Peter W Groeneveld2,3,5,9, Jay Giri1,2,3,9. 1. Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (A.S.N., S.A.K., J.G.). 2. Leonard Davis Institute of Health Economics (A.S.N., S.A.K., E.D., P.C., N.D.D., P.W.G., J.G.), University of Pennsylvania, Philadelphia, PA. 3. Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Institute (A.S.N., S.A.K., E.D., N.D.D., P.W.G., J.G.), University of Pennsylvania, Philadelphia, PA. 4. Baylor College of Medicine, Houston, TX (R.M.S.). 5. Division of General Internal Medicine, Perelman School of Medicine (P.C., P.W.G.), University of Pennsylvania, Philadelphia, PA. 6. Division of Cardiovascular Surgery (N.D.D.), University of Pennsylvania, Philadelphia, PA. 7. Division of Cardiology, University of Colorado School of Medicine, Aurora (S.W.W.). 8. Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.). 9. Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (P.W.G., J.G.).
Abstract
BACKGROUND: Public reporting of cardiovascular outcomes has been associated with risk aversion for potentially lifesaving procedures and may have spillover effects on nonreported but related procedures. METHODS AND RESULTS: A cross-sectional analysis of the utilization of coronary angiography among patients presenting with out-of-hospital cardiac arrest between 2005 and 2011 in states with public reporting of percutaneous coronary intervention outcomes (New York and Massachusetts) versus neighboring states without public reporting of percutaneous coronary intervention outcomes (Delaware, Connecticut, Maine, Vermont, Maryland, and Rhode Island) was performed using the Nationwide Inpatient Sample. We analyzed 50 125 admission records with out-of-hospital cardiac arrest between 2005 and 2011. The unadjusted rate of coronary angiography for patients presenting with out-of-hospital cardiac arrest in states with public reporting versus without public reporting was not different (20.8% versus 22.8%, P=0.35). We found no statistically significant difference in the adjusted likelihood of coronary angiography in states with public reporting, though the point estimate suggested decreased utilization (odds ratio, 0.84; 95% CI, 0.66-1.06; P=0.14). There was no difference in the adjusted likelihood of in-hospital mortality for patients presenting with out-of-hospital cardiac arrest in states with public reporting compared to states without public reporting (odds ratio, 0.98; 95% CI, 0.78-1.23; P=0.88). CONCLUSIONS: Public reporting of percutaneous coronary intervention outcomes was associated with a nonstatistically significant reduction in the utilization of diagnostic coronary angiography, a nonreported but related procedure, for patients with out-of-hospital cardiac arrest.
BACKGROUND: Public reporting of cardiovascular outcomes has been associated with risk aversion for potentially lifesaving procedures and may have spillover effects on nonreported but related procedures. METHODS AND RESULTS: A cross-sectional analysis of the utilization of coronary angiography among patients presenting with out-of-hospital cardiac arrest between 2005 and 2011 in states with public reporting of percutaneous coronary intervention outcomes (New York and Massachusetts) versus neighboring states without public reporting of percutaneous coronary intervention outcomes (Delaware, Connecticut, Maine, Vermont, Maryland, and Rhode Island) was performed using the Nationwide Inpatient Sample. We analyzed 50 125 admission records with out-of-hospital cardiac arrest between 2005 and 2011. The unadjusted rate of coronary angiography for patients presenting with out-of-hospital cardiac arrest in states with public reporting versus without public reporting was not different (20.8% versus 22.8%, P=0.35). We found no statistically significant difference in the adjusted likelihood of coronary angiography in states with public reporting, though the point estimate suggested decreased utilization (odds ratio, 0.84; 95% CI, 0.66-1.06; P=0.14). There was no difference in the adjusted likelihood of in-hospital mortality for patients presenting with out-of-hospital cardiac arrest in states with public reporting compared to states without public reporting (odds ratio, 0.98; 95% CI, 0.78-1.23; P=0.88). CONCLUSIONS: Public reporting of percutaneous coronary intervention outcomes was associated with a nonstatistically significant reduction in the utilization of diagnostic coronary angiography, a nonreported but related procedure, for patients with out-of-hospital cardiac arrest.
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Authors: Ashwin S Nathan; Qun Xiang; Daniel Wojdyla; Sameed Ahmed M Khatana; Elias J Dayoub; Rishi K Wadhera; Deepak L Bhatt; Daniel M Kolansky; Ajay J Kirtane; Sunil V Rao; Robert W Yeh; Peter W Groeneveld; Tracy Y Wang; Jay Giri Journal: JAMA Cardiol Date: 2020-07-01 Impact factor: 14.676