Association between public reporting of outcomes with procedural management and mortality for patients with acute myocardial infarction.
Association between public reporting of outcomes with procedural management and mortality for patients with acute myocardial infarction.
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DOI：
10.1016/j.jacc.2015.01.008
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发表时间：
2015-03-24
影响因子：
24
通讯作者：
Yeh, Robert W.
中科院分区：
文献类型：
--
作者：
Waldo, Stephen W.;McCabe, James M.;O'Brien, Cashel;Kennedy, Kevin F.;Joynt, Karen E.;Yeh, Robert W.
对结果的公开报道可能会阻碍危重患者接受经皮冠状动脉介入治疗(PCI)。评估急性心肌梗死(AMI)患者的公开报告与程序管理和预后之间的关系。使用全国住院患者样本，我们确定了2005至2011年间有公开报告的州(马萨诸塞州和纽约州)和区域可比州(康涅狄格州、缅因州、马里兰州、新罕布夏州、罗德岛州和佛蒙特州)的所有初步诊断为急性心肌梗死的患者。程序性管理和住院结果通过公共报告进行分层。在84,121名住院的急性心肌梗死患者中，57,629人(69%)在公开报告状态下接受治疗。在多变量调整后，与未报告状态相比，在公共报告状态下进行经皮血管重建术的频率较低(OR：0.81，95%CI：0.67-0.96)，特别是在老年患者(0.75，95%CI：0.62-0.91)、有医疗保险的患者(OR：0.75，95%CI：0.62-0.91)以及STEMI患者(OR：0.63，95%CI：0.56-0.71)或合并心脏骤停或心源性休克的患者(OR：0.58，95%可信区间：0.47~0.70)。总体而言，与未报告状态相比，处于公开报告状态的急性心肌梗死患者的调整后住院死亡率更高(OR：1.21，95%CI：1.06-1.37)。这主要见于在公开报告状态下未接受经皮血管重建术的患者(调整后的OR：1.30，95%CI：1.13-1.50)，而接受该手术的患者死亡率较低(OR：0.71，95%CI：0.62-0.83)。公开报道与急性心肌梗死患者，特别是非经皮冠状动脉介入治疗患者的经皮血管重建减少和住院死亡率增加有关。
Public reporting of outcomes may create disincentives to provide percutaneous coronary intervention (PCI) for critically ill patients. Evaluate the association between public reporting with procedural management and outcomes among patients with acute myocardial infarction (AMI). 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. Among 84,121 patients hospitalized with AMI, 57,629 (69%) underwent treatment in a public reporting state. After multivariable adjustment, percutaneous revascularization was performed less often in public reporting states compared with non-reporting states (OR: 0.81, 95%CI: 0.67 – 0.96), especially among older patients (0.75, 95%CI: 0.62 – 0.91), those with Medicare insurance (OR: 0.75, 95%CI: 0.62 – 0.91) and those presenting with STEMI (OR: 0.63, 95%CI: 0.56 – 0.71) or concomitant cardiac arrest or cardiogenic shock (OR: 0.58, 95%CI: 0.47 – 0.70). Overall, patients with AMI in public reporting states had higher adjusted in-hospital mortality (OR: 1.21, 95%CI: 1.06 – 1.37), compared with non-reporting states. This was predominately observed in patients that did not receive percutaneous revascularization in public reporting states (adjusted OR: 1.30, 95%CI: 1.13 – 1.50) while those undergoing the procedure had lower mortality (OR: 0.71, 95%CI: 0.62 – 0.83). Public reporting is associated with reduced percutaneous revascularization and increased in-hospital mortality among patients with AMI, particularly among patients not selected for PCI.
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