Public Reporting Could Decrease Surgeries, Increase Mortality

Researchers found that public reporting of mortality outcomes after cardiac procedures may make physicians less likely to offer treatment to high-risk patients.

In a study published by JAMA Cardiology, researchers examined discharge records for more than 45,000 patients who experienced a severe heart attack and cardiogenic shock. Researchers found that physicians were more likely to perform percutaneous coronary intervention (PCI) after these patients were omitted from public reporting.

They also found a decrease in mortality among these patients. Researchers believe that physicians may not perform riskier procedures that would benefit the patient due to public reporting criteria.

“The drop in mortality we observed suggests that changing the policy to exclude the sickest patients changed physician behavior and may have also improved public health,” said corresponding author Robert Yeh, MD, MSc. “Our previous work found that elderly patients or those presenting with shock or cardiac arrest were even less likely to undergo a potentially lifesaving procedure in states with public reporting.”

Public reporting criteria included mortality outcomes after PCI in New York in 1992, but patients with cardiogenic shock began being excluded in 2006. New York Department of Public Health believed that including these patients would cause physicians to not recommend the surgery.

“This change in policy in New York provided us with a unique opportunity to study the effects of excluding certain patients from public reporting on physician behavior,” said lead researcher James McCabe, MD. “We were able to design a study that compared treatment strategies and outcomes before and after the policy change in New York, and simultaneously compare these to what was happening in other states that did not change their policies.”

Researchers also analyzed records of patients with acute myocardial infarction and shock from 2002 to 2011. They compared data from New York pre- and post-requirement change with data from Massachusetts, Michigan, New Jersey, and California.

They discovered that after 2006 in New York, cardiologists were 28% more likely to perform a high-risk PCI. In the other states, it only increased 9%.

The mortality rate for these patients also decreased by 24% in New York after 2006, compared with a 9% decrease in the other states.

“There is great enthusiasm for expanding public reporting of procedural outcomes, but the manner in which these policies are implemented can determine whether they ultimately prove beneficial or harmful to patient health,” Dr Yeh concluded. “We hope this study can help shape future policies aimed at improving both transparency and outcomes for cardiac procedures.”