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Chow C, Doll J. Contemporary Risk Models for In-Hospital and 30-Day Mortality After Percutaneous Coronary Intervention. Curr Cardiol Rep 2024; 26:451-457. [PMID: 38592570 DOI: 10.1007/s11886-024-02047-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE OF REVIEW Risk models for mortality after percutaneous coronary intervention (PCI) are underutilized in clinical practice though they may be useful during informed consent, risk mitigation planning, and risk adjustment of hospital and operator outcomes. This review analyzed contemporary risk models for in-hospital and 30-day mortality after PCI. RECENT FINDINGS We reviewed eight contemporary risk models. Age, sex, hemodynamic status, acute coronary syndrome type, heart failure, and kidney disease were consistently found to be independent risk factors for mortality. These models provided good discrimination (C-statistic 0.85-0.95) for both pre-catheterization and comprehensive risk models that included anatomic variables. There are several excellent models for PCI mortality risk prediction. Choice of the model will depend on the use case and population, though the CathPCI model should be the default for in-hospital mortality risk prediction in the United States. Future interventions should focus on the integration of risk prediction into clinical care.
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Affiliation(s)
- Christine Chow
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jacob Doll
- Department of Medicine, University of Washington, Seattle, WA, USA.
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2
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Ofosu-Somuah A, Cavender MA, Stouffer GA. Another Step Forward in Our Ability to Predict Percutaneous Coronary Intervention Outcomes. Am J Cardiol 2023; 206:332-333. [PMID: 37730513 DOI: 10.1016/j.amjcard.2023.08.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Affiliation(s)
- Araba Ofosu-Somuah
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina; The McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| | - Matthew A Cavender
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina; The McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina
| | - George A Stouffer
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina; The McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina.
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3
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Smilowitz NR, Rao SV. Age or Functional Debility to Predict Death After Percutaneous Coronary Intervention: Age Is More Than a Number. Mayo Clin Proc 2023; 98:1110-1112. [PMID: 37536797 DOI: 10.1016/j.mayocp.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Nathaniel R Smilowitz
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY; Cardiology Section, Department of Medicine, VA New York Harbor Healthcare System, New York, NY
| | - Sunil V Rao
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, NYU Langone Health, New York, NY.
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4
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Yamana H, Lee S, Lin YC, Yoon NH, Fushimi K, Yasunaga H, Cheng SH, Kim H. Institutional Variance in Mortality after Percutaneous Coronary Intervention for Acute Myocardial Infarction in Korea, Japan, and Taiwan. Int J Health Policy Manag 2023; 12:6796. [PMID: 37579412 PMCID: PMC10461903 DOI: 10.34172/ijhpm.2023.6796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Although there have been studies that compared outcomes of patients with acute myocardial infarction (AMI) across countries, little focus has been placed on institutional variance of outcomes. The aim of the present study was to compare institutional variance in mortality following percutaneous coronary intervention (PCI) for AMI and factors explaining this variance across different health systems. METHODS Data on inpatients who underwent PCI for AMI in 2016 were obtained from the National Health Insurance Data Sharing Service in Korea, the Diagnosis Procedure Combination (DPC) Study Group Database in Japan, and the National Health Insurance Research Database (NHIRD) in Taiwan. Multilevel analyses with inpatient mortality as the outcome and the hierarchical structure of patients nested within hospitals were conducted, adjusting for common patient-level and hospital-level variables. We compared the intraclass correlation coefficient (ICC) and the proportion of variance explained by hospital-level characteristics across the three health systems. RESULTS There were 17 351 patients from 160 Korean hospitals, 29 804 patients from 660 Japanese hospitals, and 10 863 patients from 104 Taiwanese hospitals included in the analysis. Inpatient mortality rates were 6.3%, 7.3%, and 6.0% in Korea, Japan, and Taiwan, respectively. After adjusting for patient and hospital characteristics, Taiwan had the lowest variation in mortality (ICC, 1.8%), followed by Korea (2.2%) and then Japan (4.5%). The measured hospital characteristics explained 38%, 19%, and 9% of the institutional variance in Korea, Taiwan, and Japan, respectively. CONCLUSION Korea, Japan, and Taiwan had similarly uniform outcomes across hospitals for patients undergoing PCI for AMI. However, Japan had a relatively large institutional variance in mortality and a lower proportion of variation explainable by hospital characteristics, compared with Korea and Taiwan.
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Affiliation(s)
- Hayato Yamana
- Data Science Center, Jichi Medical University, Shimotsuke, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Seyune Lee
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - Yi-Chieh Lin
- Department of Healthcare Administration, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Nan-He Yoon
- Division of Social Welfare and Health Administration, Wonkwang University, Iksan, South Korea
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hongsoo Kim
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Institute of Aging, Seoul National University, Seoul, South Korea
- SOCIUM - Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
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5
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Kovach CP, Gunzburger EC, Morrison JT, Valle JA, Doll JA, Waldo SW. Influence of Major Adverse Events on Procedural Selection for Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment Reporting and Tracking Program. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100460. [PMID: 39132338 PMCID: PMC11307526 DOI: 10.1016/j.jscai.2022.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 08/13/2024]
Abstract
Background Public reporting of percutaneous coronary intervention (PCI) outcomes has been associated with risk-averse attitudes, and pressure to avoid negative outcomes may hinder the care of high-risk patients referred for PCI in public reporting environments. It is unknown whether the occurrence of PCI-related major adverse events (MAEs) influences future case selection in nonpublic reporting environments. Here, we describe trends in PCI case selection among patients undergoing coronary angiography following MAEs in Veterans Affairs (VA) cardiac catheterization laboratories participating in a mandatory internal quality improvement program without public reporting of outcomes. Methods Patients who underwent coronary angiography between October 1, 2010, and September 30, 2018, were identified and stratified by VA 30-day PCI mortality risk. The association between MAEs and changes in the proportion of patients proceeding from coronary angiography to PCI within 14 days was assessed. Results A total of 251,526 patients and 913 MAEs were included in the analysis. For each prespecified time period of 1, 2, and 4 weeks following an MAE, there were no significant changes in the proportion of patients undergoing coronary angiography who proceeded to PCI within 14 days for the overall cohort and for each tercile of VA 30-day PCI mortality risk. Conclusions There were no deviations from routine PCI referral practices following MAEs in this analysis of VA cardiac catheterization laboratories. Nonpublic reporting environments and quality improvement programs may be influential in mitigating PCI risk-aversion behaviors.
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Affiliation(s)
- Christopher P. Kovach
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Elise C. Gunzburger
- Center of Innovation, Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado
- Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado
| | - Justin T. Morrison
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado
| | - Javier A. Valle
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado
- Michigan Heart and Vascular Institute, Ann Arbor, Michigan
| | - Jacob A. Doll
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
- Clinical Assessment Reporting and Tracking Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
- Puget Sound Veterans Affairs Health Care System, Seattle, Washington
| | - Stephen W. Waldo
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora, Colorado
- Center of Innovation, Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado
- Rocky Mountain Veterans Affairs Medical Center, Aurora, Colorado
- Clinical Assessment Reporting and Tracking Program, Office of Quality and Patient Safety, Veterans Health Administration, Washington, DC
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6
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Oseran AS, Wadhera RK. Improving Quality Improvement-From Aspiration Toward Empiricism. JAMA Cardiol 2022; 7:912-913. [PMID: 35947368 DOI: 10.1001/jamacardio.2022.2493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew S Oseran
- Section of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Division of Cardiology, Massachusetts General Hospital, Boston
| | - Rishi K Wadhera
- Section of Health Policy and Equity, Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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7
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Affiliation(s)
- Lisa Rosenbaum
- Dr. Rosenbaum is a national correspondent for the Journal
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8
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Henke RM. Out of Pocket Costs and Health Care Utilization. Am J Health Promot 2022; 36:738-740. [PMID: 35420450 DOI: 10.1177/08901171211073408d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rachel Mosher Henke
- IBM, Sr Director of Economic and Evaluation Research, IBM Consulting, Cambridge MA, USA
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9
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Henke RM. Knowing Well, Being Well: well-being born of understanding: Out of Pocket Costs and Health Care Utilization. Am J Health Promot 2022; 36:738-752. [PMID: 35420447 DOI: 10.1177/08901171211073408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Rachel Mosher Henke
- IBM, Sr Director of Economic and Evaluation Research, IBM Consulting, Cambridge MA, USA
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10
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Nguyen DD, Doll JA. Quality Improvement and Public Reporting in STEMI Care. Interv Cardiol Clin 2021; 10:391-400. [PMID: 34053625 DOI: 10.1016/j.iccl.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mortality rates for patients with ST-segment elevation myocardial infarction (STEMI) remain high despite development of novel drugs and interventions over the past several decades. There is significant variability between hospitals in use of evidence-based treatments, and substantial opportunities exist to optimize care pathways and reduce disparities in care delivery. Quality improvement interventions implemented at local, regional, and national levels have improved care processes and patient outcomes. This article reviews evidence for quality improvement interventions along the spectrum of STEMI care, describes existing systems for quality measurement, and examines local and national policy interventions, with special attention to public reporting programs.
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Affiliation(s)
- Dan D Nguyen
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA
| | - Jacob A Doll
- Division of Cardiology, Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA; VA Puget Sound Health Care System, 1660 S Columbian Way, Seattle, WA 98108, USA.
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11
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Yang N, Groeneveld PW, Khatana SAM, Giri J, Fanaroff AC, Nathan AS. Variability in Reported Percutaneous Coronary Intervention Mortality Among Physicians Practicing at Multiple Sites in New York State. JAMA Cardiol 2021; 6:477-478. [PMID: 33377935 DOI: 10.1001/jamacardio.2020.6717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Nancy Yang
- University of Pennsylvania School of Arts and Sciences, Philadelphia
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Perelman School of Medicine, Division of General Internal Medicine, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia
| | - Sameed Ahmed Mustafa Khatana
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz VA Medical Center, Philadelphia.,Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Ashwin S Nathan
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
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12
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Nathan AS, Xiang Q, Wojdyla D, Khatana SAM, Dayoub EJ, Wadhera RK, Bhatt DL, Kolansky DM, Kirtane AJ, Rao SV, Yeh RW, Groeneveld PW, Wang TY, Giri J. Performance of Hospitals When Assessing Disease-Based Mortality Compared With Procedural Mortality for Patients With Acute Myocardial Infarction. JAMA Cardiol 2021; 5:765-772. [PMID: 32347890 DOI: 10.1001/jamacardio.2020.0753] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Importance Quality of percutaneous coronary intervention (PCI) is commonly assessed by risk-adjusted mortality. However, this metric may result in procedural risk aversion, especially for high-risk patients. Objective To determine correlation and reclassification between hospital-level disease-specific mortality and PCI procedural mortality among patients with acute myocardial infarction (AMI). Design, Setting, and Participants This hospital-level observational cross-sectional multicenter analysis included hospitals participating in the Chest Pain-MI Registry, which enrolled consecutive adult patients admitted with a diagnosis of type I non-ST-segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI), and hospitals in the CathPCI Registry, which enrolled consecutive adult patients treated with PCI with an indication of NSTEMI or STEMI, between April 1, 2011, and December 31, 2017. Exposures Inclusion into the National Cardiovascular Data Registry Chest Pain-MI and CathPCI registries. Main Outcomes and Measures For each hospital in each registry, a disease-based excess mortality ratio (EMR-D) for AMI was calculated, which represents a risk-adjusted observed to expected rate of mortality for AMI as a disease using the Chest Pain-MI Registry, and a procedure-based excess mortality ratio (EMR-P) for PCI was calculated using the CathPCI Registry. Results A subset of 625 sites participated in both registries, with a final count of 776 890 patients from the Chest Pain-MI Registry (509 576 men [65.6%]; 620 981 white [80.0%]; and median age, 64 years [interquartile range, 55-74 years]) and 853 386 patients from the CathPCI Registry (582 701 men [68.3%]; 691 236 white [81.0%]; and median age, 63 years [interquartile range, 54-73 years]). Among the 625 linked hospitals, the Spearman rank correlation coefficient between EMR-D and EMR-P produced a ρ of 0.53 (95% CI, 0.47-0.58), suggesting moderate correlation. Among the highest-performing tertile for disease-based risk-adjusted mortality, 90 of 208 sites (43.3%) were classified into a lower category for procedural risk-adjusted mortality. Among the lowest-performing tertile for disease-based risk-adjusted mortality, 92 of 208 sites (44.2%) were classified into a higher category for procedural risk-adjusted mortality. Bland-Altman plots for the overall linked cohort demonstrate a mean difference between EMR-P and EMR-D of 0.49% (95% CI, -1.61% to 2.58%; P < .001), with procedural mortality higher than disease-based mortality. However, among patients with AMI complicated by cardiogenic shock or cardiac arrest, the mean difference between EMR-P and EMR-D was -0.64% (95% CI, -4.41% to 3.12%; P < .001), with procedural mortality lower than disease-based mortality. Conclusions and Relevance This study suggests that, for hospitals treating patients with AMI, there is only a moderate correlation between procedural outcomes and disease-based outcomes. Nearly half of hospitals in the highest tertile of performance for PCI performance were reclassified into a lower performance tertile when judged by disease-based metrics. Higher rates of mortality were observed when using disease-based metrics compared with procedural metrics when assessing patients with cardiogenic shock and/or cardiac arrest, signifying what appears to be potential risk avoidance among this highest-risk subset of patients.
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Affiliation(s)
- Ashwin S Nathan
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
| | - Qun Xiang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Sameed Ahmed M Khatana
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
| | - Elias J Dayoub
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Rishi K Wadhera
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.,Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Deepak L Bhatt
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Daniel M Kolansky
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia
| | - Ajay J Kirtane
- Cardiovascular Division, Columbia-New York Presbyterian Hospital, New York, New York
| | - Sunil V Rao
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Peter W Groeneveld
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Jay Giri
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
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13
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Nerenz DR, Cella D, Fabian L, Nuccio E, Bott J, Austin JM, Simon S, Needleman J, Johnson K. The NQF Scientific Methods Panel. Am J Med Qual 2020; 35:458-464. [DOI: 10.1177/1062860620914026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Kini V, Hess PL, Liu W, Grunwald G, Ho PM, Bradley SM. Association Between Elective Percutaneous Coronary Intervention Appropriateness and Publicly Reported Outcomes. Circ Cardiovasc Qual Outcomes 2020; 14:e007421. [PMID: 33161758 DOI: 10.1161/circoutcomes.120.007421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vinay Kini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO (V.K., P.L.H., P.M.H.)
| | - Paul L Hess
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO (V.K., P.L.H., P.M.H.).,Veterans Affairs Eastern Colorado Healthcare System, Aurora, CO (P.L.H., W.L.)
| | - Wenhui Liu
- Veterans Affairs Eastern Colorado Healthcare System, Aurora, CO (P.L.H., W.L.)
| | | | - P Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO (V.K., P.L.H., P.M.H.)
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15
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Risk-Adjusting Key Outcome Measures in a Clinical Quality PCI Registry: Development of a Highly Predictive Model Without the Need to Exclude High-Risk Conditions. JACC Cardiovasc Interv 2020; 12:1966-1975. [PMID: 31601391 DOI: 10.1016/j.jcin.2019.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 06/25/2019] [Accepted: 07/02/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study sought to determine the most risk-adjustment model for 30-day all-cause mortality in order to report risk-adjusted outcomes. The study also explored whether the exclusion of extreme high-risk conditions of cardiogenic shock, intubated out-of-hospital cardiac arrest (OHCA), or the need for mechanical ventricular support affected the model's predictive accuracy. BACKGROUND Robust risk-adjustment models are a critical component of clinical quality registries, allowing outcomes to be reported in a fair and meaningful way. The Victorian Cardiac Outcomes Registry encompasses all 30 hospitals in the state of Victoria, Australia, that undertake percutaneous coronary intervention. METHODS Data were collected on 27,544 consecutive percutaneous coronary intervention procedures from 2014 to 2016. Twenty-eight patient risk factors and procedural variables were considered in the modeling process. The multivariable logistic regression analysis considered derivation and validation datasets, along with a temporal validation period. RESULTS The model included risk-adjustment for cardiogenic shock, intubated OHCA, estimated glomerular filtration rate, left ventricular ejection fraction, angina type, mechanical ventricular support, ≥80 years of age, lesion complexity, percutaneous access site, and peripheral vascular disease. The C-statistic for the derivation dataset was 0.921 (95% confidence interval: 0.905 to 0.936), with C-statistics of 0.931 and 0.934 for 2 validation datasets reflecting the 2014 to 2016 and 2017 periods. Subgroup modeling excluding cardiogenic shock and intubated OHCA provided similar risk-adjusted outcomes (p = 0.32). CONCLUSIONS Our study has developed a highly predictive risk-adjustment model for 30-day mortality that included high-risk presentations. Therefore, we do not need to exclude high-risk cases in our model when determining risk-adjusted outcomes.
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16
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Berg DD, Bobrow BJ, Berg RA. Key components of a community response to out-of-hospital cardiac arrest. Nat Rev Cardiol 2020; 16:407-416. [PMID: 30858511 DOI: 10.1038/s41569-019-0175-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) remains a leading cause of death worldwide, with substantial geographical, ethnic and socioeconomic disparities in outcome. Successful resuscitation efforts depend on the 'chain of survival', which includes immediate recognition of cardiac arrest and activation of the emergency response system, early bystander cardiopulmonary resuscitation (CPR) with an emphasis on chest compressions, rapid defibrillation, basic and advanced emergency medical services and integrated post-cardiac arrest care. Well-orchestrated telecommunicator CPR programmes can improve rates of bystander CPR - a critical link in the chain of survival. High-performance CPR by emergency medical service providers includes minimizing interruptions in chest compressions and ensuring adequate depth of compressions. Developing local, regional and statewide systems with dedicated high-performing cardiac resuscitation centres for post-resuscitation care can substantially improve survival after OHCA. Innovative digital tools for recognizing cardiac arrest where and when it occurs, notifying potential citizen rescuers and providing automated external defibrillators at the scene hold the promise of improving survival after OHCA. Improved implementation of the chain of survival can save thousands of lives each year.
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Affiliation(s)
- David D Berg
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Bentley J Bobrow
- Department of Emergency Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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17
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Public reporting of PCI operator outcomes. Aging (Albany NY) 2019; 11:11797-11798. [PMID: 31848321 PMCID: PMC6949075 DOI: 10.18632/aging.102624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022]
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18
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Sandhu AT, Kohsaka S, Bhattacharya J, Fearon WF, Harrington RA, Heidenreich PA. Association Between Current and Future Annual Hospital Percutaneous Coronary Intervention Mortality Rates. JAMA Cardiol 2019; 4:1077-1083. [PMID: 31532454 DOI: 10.1001/jamacardio.2019.3221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Multiple states publicly report a hospital's risk-adjusted mortality rate for percutaneous coronary intervention (PCI) as a quality measure. However, whether reported annual PCI mortality is associated with a hospital's future performance is unclear. Objective To evaluate the association between reported risk-adjusted hospital PCI-related mortality and a hospital's future PCI-related mortality. Design, Setting, and Participants This study used data from the New York Percutaneous Intervention Reporting System from January 1, 1998, to December 31, 2016, to assess hospitals that perform PCI. Exposures Public-reported, risk-adjusted, 30-day mortality after PCI. Main Outcomes and Measures The primary analysis evaluated the association between a hospital's reported risk-adjusted PCI-related mortality and future PCI-related mortality. The correlation between a hospital's observed to expected (O/E) PCI-related mortality rates each year and future O/E mortality ratios was assessed. Multivariable linear regression was used to examine the association between index year O/E mortality and O/E mortality in subsequent years while adjusting for PCI volume and patient severity. Results This study included 67 New York hospitals and 960 hospital-years. Hospitals with low PCI-related mortality (O/E mortality ratio, ≤1) and high mortality (O/E mortality ratio, >1) had inverse associations between their O/E mortality ratio in the index year and the subsequent change in the ratio (hospitals with low mortality, r = -0.45; hospitals with high mortality, r = -0.60). Little of the variation in risk-adjusted mortality was explained by prior performance. An increase in the O/E mortality ratio from 1.0 to 2.0 in the index year was associated with a higher O/E mortality ratio of only 0.15 (95% CI, 0.02-0.27) in the following year. Conclusions and Relevance At hospitals with high or low PCI-related mortality rates, the rates largely regressed to the mean the following year. A hospital's risk-adjusted mortality rate was poorly associated with its future mortality. The annual hospital PCI-related mortality may not be a reliable factor associated with hospital quality to consider in a practice change or when helping patients select high-quality hospitals.
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Affiliation(s)
- Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Shun Kohsaka
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Jay Bhattacharya
- Center for Health Policy, Department of Medicine, Stanford University, Stanford, California.,Center for Primary Care and Outcomes Research, Department of Medicine, Stanford University, Stanford, California
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert A Harrington
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Paul A Heidenreich
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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19
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Reply. J Am Coll Cardiol 2019; 74:2219. [DOI: 10.1016/j.jacc.2019.08.1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/18/2019] [Indexed: 11/17/2022]
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20
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Bricker RS, Valle JA, Plomondon ME, Armstrong EJ, Waldo SW. Causes of Mortality After Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2019; 12:e005355. [DOI: 10.1161/circoutcomes.118.005355] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rory S. Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Javier A. Valle
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Mary E. Plomondon
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Ehrin J. Armstrong
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
| | - Stephen W. Waldo
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, Aurora (R.B., J.A.V., M.E.P., E.J.A., S.W.W.)
- Department of Medicine, Rocky Mountain Regional VA Medical Center, Aurora, CO (J.A.V., M.E.P., E.J.A., S.W.W.)
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Wadhera RK, O'Brien CW, Joynt Maddox KE, Ho KKL, Pinto DS, Resnic FS, Shah PB, Yeh RW. Public Reporting of Percutaneous Coronary Intervention Outcomes: Institutional Costs and Physician Burden. J Am Coll Cardiol 2019; 73:2604-2608. [PMID: 30885686 DOI: 10.1016/j.jacc.2019.03.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Colin W O'Brien
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Karen E Joynt Maddox
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Kalon K L Ho
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Duane S Pinto
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Frederic S Resnic
- Division of Cardiovascular Medicine, Lahey Hospital and Medical Center and Tufts University School of Medicine, Burlington, Massachusetts
| | - Pinak B Shah
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Robert W Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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22
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Wadhera RK, Bhatt DL. Public Reporting of Percutaneous Coronary Intervention Outcomes Done Differently-Leading From Washington-Reply. JAMA Cardiol 2018; 3:1127-1128. [PMID: 30267100 DOI: 10.1001/jamacardio.2018.3010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rishi K Wadhera
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts.,Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
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23
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Hira RS, Ring M, Dunbar P. Public Reporting of Percutaneous Coronary Intervention Outcomes Done Differently-Leading From Washington. JAMA Cardiol 2018; 3:1126-1127. [PMID: 30267059 DOI: 10.1001/jamacardio.2018.3000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ravi S Hira
- Clinical Outcomes Assessment Program, Foundation for Health Care Quality, Seattle, Washington.,Division of Cardiology, University of Washington, Seattle
| | - Michael Ring
- Clinical Outcomes Assessment Program, Foundation for Health Care Quality, Seattle, Washington.,Providence Sacred Heart Medical Center, Spokane, Washington
| | - Peter Dunbar
- Clinical Outcomes Assessment Program, Foundation for Health Care Quality, Seattle, Washington
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Wadhera RK, Yeh RW. Inadequate Surrogates for Imperfect Quality Measures. Circ Cardiovasc Interv 2018; 11:e007216. [PMID: 30354606 DOI: 10.1161/circinterventions.118.007216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rishi K Wadhera
- Brigham and Women's Hospital Heart and Vascular Center (R.K.W.), Harvard Medical School, Boston, MA.,Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center (R.K.W., R.W.Y.), Harvard Medical School, Boston, MA
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical Center (R.K.W., R.W.Y.), Harvard Medical School, Boston, MA
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25
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Wang DE, Wadhera RK, Bhatt DL. Public reporting of percutaneous coronary interventions. Med J Aust 2018; 209:104-105. [PMID: 30071811 DOI: 10.5694/mja18.00569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 06/14/2018] [Indexed: 11/17/2022]
Affiliation(s)
| | - Rishi K Wadhera
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, Mass, USA
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