Impact of Percutaneous Coronary Intervention Performance Reporting on Cardiac Resuscitation Centers: A Scientific Statement From the American Heart Association
Impact of Percutaneous Coronary Intervention Performance Reporting on Cardiac Resuscitation Centers: A Scientific Statement From the American Heart Association
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DOI：
10.1161/cir.0b013e3182a15cd2
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发表时间：
2013-08-13
期刊：
影响因子：
37.8
通讯作者：
Ferguson, T. Bruce, Jr.
中科院分区：
文献类型：
--
作者：
Peberdy, Mary Ann;Donnino, Michael W.;Ferguson, T. Bruce, Jr.
Peberdy等人PCI报告对心脏骤停中心763报销的影响，以及个人和医院层面的奖励计划。OHCA患者的生存率远低于非CA STEMI-PCI患者。照顾中等数量的休息后患者的医院，例如AHA推荐的1级CRC，将更多这些典型昏迷的全身危重患者带到导管室进行紧急冠状动脉造影和PCI。即使在最好的报告情况下，在最初复苏的总体休息后人群中的死亡率也是50%左右。[13]这50%的存活率是使用这种积极的捆绑式术后护理之前的长期存活率的两倍。[13]这种积极的休息后血运重建方法5 -10，12-21产生了意想不到的后果，导致执行高容量、高质量休息后护理类型的中心（遵循I类AHA指南）的死亡率明显高于每年仅治疗少数休息后患者的医院。适当的休息后患者亚组立即进入导管室，涉及治疗许多最终死于神经或多器官衰竭而不是心血管死亡的患者，22但他们的死亡与所有其他STEMI患者同时报告，其中大多数患者的围手术期死亡率低10倍。由于联邦和州政府强制要求的结果公开报告已被证明会影响医生在选择是否接受高风险患者进行救生手术时的决策，因此介入心脏病专家和医院有可能不得不在保护其公开报告的声誉或危及未来报销之间做出决定，并提供证据证明是最好的临床护理。23本科学声明的目的是描述在PCI死亡率的公开报告中纳入OHCA STEMI患者的潜在影响，并提出修改该人群当前结局报告程序的建议。
Peberdy et al Impact of PCI Reporting on Cardiac Arrest Centers 763 reimbursement, as well as individual and hospital-level reward programs. Patients with OHCA have much lower survival rates than non-CA STEMI-PCI patients. Hospitals that care for moderate numbers of postarrest patients, such as the level 1 CRCs recommended by the AHA, take more of these typically comatose, systemically critically ill patients to the catheterization laboratory for emergency coronary angiography and PCI. Even under the best reported circumstances, mortality in the overall postarrest population who have been initially resuscitated is≈ 50%. 13 This 50% survival is double the previous long-term survival rate before such aggressive bundled postarrest care was used. 13 Such an aggressive postarrest revascularization approach5–10, 12–21 has the unintended consequence of causing the centers that perform the type of highvolume, quality postarrest care that follows a Class I AHA guideline to have significantly higher mortality than hospitals that treat only a few postarrest patients annually. Appropriate subsets of postarrest patients being given immediate access to the catheterization laboratory involves treating many patients who will ultimately succumb to neurological or multiorgan failure rather than a cardiovascular death, 22 yet their deaths are reported simultaneously with all other STEMI patients, the majority of whom have a 10-fold lower periprocedural mortality. Because federal-and state-mandated public reporting of outcomes has been shown to influence physician decision making in choosing whether to take high-risk patients for lifesaving procedures, the potential exists for interventional cardiologists and hospitals to have to decide between protecting their publicly reported reputation or jeopardizing future reimbursement and providing what the evidence has demonstrated to be the best clinical care for their patient. 23 The purpose of this scientific statement is to describe the potential impact of including OHCA patients with STEMI in the public reporting of PCI mortality and to make recommendations for modifications in the current outcomes-reporting procedures in this population.