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Blumenthal DM, Valsdottir LR, Zhao Y, Shen C, Kirtane AJ, Pinto DS, Resnic FS, Maddox KEJ, Wasfy JH, Mehran R, Rosenfield K, Yeh RW. A Survey of Interventional Cardiologists' Attitudes and Beliefs About Public Reporting of Percutaneous Coronary Intervention. JAMA Cardiol 2019; 3:629-634. [PMID: 29801157 DOI: 10.1001/jamacardio.2018.1095] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Public reporting of procedural outcomes has been associated with lower rates of percutaneous coronary intervention (PCI) and worse outcomes after myocardial infarction. Contemporary data are limited on the influence of public reporting on interventional cardiologists' clinical decision making. Objective To survey a contemporary cohort of interventional cardiologists in Massachusetts and New York about how public reporting of PCI outcomes influences clinical decision making. Design, Setting, and Participants An online survey was developed with public reporting experts and administered electronically to eligible physicians in Massachusetts and New York who were identified by Doximity (an online physician networking site) and 2014 Medicare fee-for-service claims for PCI procedures. The personal and hospital characteristics of participants were ascertained via a comprehensive database from Doximity and the American Hospital Association annual surveys of US hospitals (2012 and 2013) and linked to survey responses. Associations between survey responses and characteristics of participants were evaluated in univariable and multivariable analyses. Main Outcomes and Measures Reported rate of avoidance of performing PCIs in high-risk patients and of perception of pressure from colleagues to avoid performing PCIs. Results Of the 456 physicians approached, 149 (32.7%) responded, including 67 of 129 (51.9%) in Massachusetts and 82 of 327 (25.1%) in New York. The mean (SD) age was 49 (9.2) years; 141 of 149 participants (94.6%) were men. Most participants reported practicing at medium to large, nonprofit hospitals with high-volume cardiac catheterization laboratories and cardiothoracic surgery capabilities. In 2014, participants had higher annual PCI volumes among Medicare patients than nonparticipants did (median, 31; interquartile range [IQR], 13-47 vs median, 17; IQR, 0-41; P < .001). Among participants, 65% reported avoiding PCIs on at least 2 occasions becase of concern that a bad outcome would negatively impact their publicly reported outcomes; 59% reported sometimes or often being pressured by colleagues to avoid performing PCIs because of a concern about the patient's risk of death. After multivariable adjustment, more years of experience practicing interventional cardiology was associated with lower odds of PCI avoidance. The state of practice was not associated with survey responses. Conclusions and Relevance Current PCI public reporting programs can foster risk-averse clinical practice patterns, which do not vary significantly between interventional cardiologists in New York and Massachusetts. Coordinated efforts by policy makers, health systems leadership, and the interventional cardiology community are needed to mitigate these unintended consequences.
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Affiliation(s)
- Daniel M Blumenthal
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Linda R Valsdottir
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Yuansong Zhao
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Changyu Shen
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Cardiology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Ajay J Kirtane
- Cardiology Division, Columbia University Medical Center, New York, New York.,Associate Editor
| | - Duane S Pinto
- Harvard Medical School, Boston, Massachusetts.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Cardiology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Fred S Resnic
- Cardiology Division, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Karen E Joynt Maddox
- Cardiovascular Division, Washington University School of Medicine, Saint Louis, Missouri
| | - Jason H Wasfy
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Roxana Mehran
- Cardiology Division, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ken Rosenfield
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Robert W Yeh
- Harvard Medical School, Boston, Massachusetts.,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Cardiology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Strom JB, McCabe JM, Waldo SW, Pinto DS, Kennedy KF, Feldman DN, Yeh RW. Management of Patients With Cardiac Arrest Complicating Myocardial Infarction in New York Before and After Public Reporting Policy Changes. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.116.004833. [PMID: 28495895 DOI: 10.1161/circinterventions.116.004833] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND In 2010, New York State began excluding selected patients with cardiac arrest and coma from publicly reported mortality statistics after percutaneous coronary intervention. We evaluated the effects of this exclusion on rates of coronary angiography, revascularization, and mortality among patients with acute myocardial infarction and cardiac arrest. METHODS AND RESULTS Using statewide hospitalization files, we identified discharges for acute myocardial infarction and cardiac arrest January 2003 to December 2013 in New York and several comparator states. A difference-in-differences approach was used to evaluate the likelihood of coronary angiography, revascularization, and in-hospital mortality before and after 2010. A total of 26 379 patients with acute myocardial infarction and cardiac arrest (5619 in New York) were included. Of these, 17 141 (65%) underwent coronary angiography, 12 183 (46.2%) underwent percutaneous coronary intervention, and 2832 (10.7%) underwent coronary artery bypass grafting. Before 2010, patients with cardiac arrest in New York were less likely to undergo percutaneous coronary intervention compared with referent states (adjusted relative risk, 0.79; 95% confidence interval, 0.73-0.85; P<0.001). This relationship was unchanged after the policy change (adjusted relative risk, 0.82; 95% confidence interval, 0.76-0.89; interaction P=0.359). Adjusted risks of in-hospital mortality between New York and comparator states after 2010 were also similar (adjusted relative risk, 0.94; 95% confidence interval, 0.87-1.02; P=0.152 for post- versus pre-2010 in New York; adjusted relative risk, 0.88; 95% confidence interval, 0.84-0.92; P<0.001 for comparator states; interaction P=0.103). CONCLUSIONS Exclusion of selected cardiac arrest cases from public reporting was not associated with changes in rates of percutaneous coronary intervention or in-hospital mortality in New York. Rates of revascularization in New York for cardiac arrest patients were lower throughout.
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Affiliation(s)
- Jordan B Strom
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., D.S.P., R.W.Y.); Division of Cardiology, University of Washington, Seattle (J.M.M.); Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver (S.W.W.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); and Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital (D.N.F.)
| | - James M McCabe
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., D.S.P., R.W.Y.); Division of Cardiology, University of Washington, Seattle (J.M.M.); Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver (S.W.W.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); and Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital (D.N.F.)
| | - Stephen W Waldo
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., D.S.P., R.W.Y.); Division of Cardiology, University of Washington, Seattle (J.M.M.); Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver (S.W.W.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); and Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital (D.N.F.)
| | - Duane S Pinto
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., D.S.P., R.W.Y.); Division of Cardiology, University of Washington, Seattle (J.M.M.); Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver (S.W.W.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); and Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital (D.N.F.)
| | - Kevin F Kennedy
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., D.S.P., R.W.Y.); Division of Cardiology, University of Washington, Seattle (J.M.M.); Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver (S.W.W.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); and Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital (D.N.F.)
| | - Dmitriy N Feldman
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., D.S.P., R.W.Y.); Division of Cardiology, University of Washington, Seattle (J.M.M.); Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver (S.W.W.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); and Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital (D.N.F.)
| | - Robert W Yeh
- From the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, MA (J.B.S., D.S.P., R.W.Y.); Division of Cardiology, University of Washington, Seattle (J.M.M.); Department of Medicine, Veterans Affairs Eastern Colorado Health Care System, Denver (S.W.W.); Division of Cardiology, St. Luke's/Mid America Heart Institute, Kansas City, MO (K.F.K.); and Greenberg Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital (D.N.F.).
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Oseran A, Wasfy JH. Cardiovascular Disease Prevention: The Role of Policy Interventions. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:43. [PMID: 28466121 DOI: 10.1007/s11936-017-0545-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OPINION STATEMENT Health outcomes in cardiovascular disease in the USA have generally been improving over the past several decades. Those gains have been related to both developments in prevention and treatment of cardiovascular disease. To further enhance improvement in health outcomes, including cardiovascular outcomes, health policies have been implemented to incentivize prevention. These policies have strong conceptual appeal and have been associated with improvements in some health metrics. However, robust research methods, accounting for bias and statistical confounding, are critical to confirm that these policies are associated with prevention of cardiovascular events for patients over time.
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Affiliation(s)
- Andrew Oseran
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Cardiac Unit Associates, Yawkey 5B, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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Resnic FS, Majithia A. Rationalizing Our Report Cards. JACC Cardiovasc Interv 2017; 10:232-234. [DOI: 10.1016/j.jcin.2016.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
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Wasfy JH, Borden WB, Secemsky EA, McCabe JM, Yeh RW. Public reporting in cardiovascular medicine: accountability, unintended consequences, and promise for improvement. Circulation 2015; 131:1518-27. [PMID: 25918041 DOI: 10.1161/circulationaha.114.014118] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jason H Wasfy
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.)
| | - William B Borden
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.)
| | - Eric A Secemsky
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.)
| | - James M McCabe
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.)
| | - Robert W Yeh
- From Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., E.A.S., R.W.Y.); Division of Cardiology, George Washington University School of Medicine and Health Sciences, Washington, DC (W.B.B.); Harvard Clinical Research Institute, Boston, MA (E.A.S., R.W.Y.); and Division of Cardiology, University of Washington Medical Center, Seattle (J.M.M.).
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Public Reporting of Percutaneous Coronary Intervention Outcomes. J Am Coll Cardiol 2015; 65:1127-9. [DOI: 10.1016/j.jacc.2015.01.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 11/19/2022]
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