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PCI outcomes not better at top-ranked hospitals

Key clinical point: Percutaneous coronary intervention (PCI) performed at the 50 “Best Hospitals” in U.S. News & World Report rankings was not associated with better outcomes, compared with PCI at other hospitals.

Major finding: There was no significant difference between ranked and nonranked hospitals for PCI-associated in-hospital mortality (adjusted OR, 0.96; 95% CI, 0.83-1.12; P = 0.64), acute kidney injury, or bleeding.

Data source: A retrospective analysis of 509,153 PCIs included in the National Cardiovascular Data Registry CathPCI Registry.

Disclosures: First author Dr. Devraj Sukul is supported by a National Institutes of Health postdoctoral research training grant. Coauthors reported disclosures including AstraZeneca, Regado Biosciences, and Pfizer, among others.

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Local hospitals do PCI well

It should be welcome news to the public that outcomes of PCI conducted at top-ranked hospitals were not superior to those of procedures performed at nonranked hospitals.

This study addresses what is often the foremost question of a patient and their family in their hometown: Is my local hospital doing a good job? To the extent measured by the variables in this study, it is reassuring that the answer appears to be “Yes.”

It is hard to argue that health care should be immune from rankings in an era where consumers have access to ratings for just about every product and service available.

However, the public may be confused regarding the multiple national hospital ranking systems that are available today, particularly since these rating systems do not consistently identify hospitals as top performers.

Each rating system uses different data sources, has its own rating methodology, defines different measures of performance, and has a different focus. Many have argued that transparency will improve health care but, for the public, this is getting to the point of “too much information.”

Gregory J. Dehmer, MD, of the Department of Medicine (Cardiology Division) Texas A&M University, and Baylor Scott & White Health, Temple, made the comments above in an accompanying editorial (JACC Cardiovasc Interv. 2017 Nov 1. doi: 10.1016/j.jcin.2017.11.001). He reported no financial relationships relevant to the topic.


 

FROM THE AHA SCIENTIFIC SESSIONS

Outcomes after percutaneous coronary intervention (PCI) are not superior when performed in U.S. hospitals ranked as “best” in a prominent national rating system as compared with nonranked hospitals, according to results of a recent retrospective analysis.

Rates of in-hospital mortality, acute kidney injury, and bleeding were similar for hospitals in the 2015 U.S. News & World Report’s “Best Hospitals” rankings and nonranked hospitals, Devraj Sukul, MD, reported at the American Heart Association Scientific Sessions.

“These findings should reassure patients that safe and appropriate PCI is being performed across the country,” said Dr. Sukul of the Division of Cardiovascular Medicine, University of Michigan, Ann Arbor.

The findings, published simultaneously (JACC Cardiovasc Interv. 2017 Nov 12. doi: 10.1016/j.jcin.2017.10.042) were based on a retrospective analysis of PCIs documented in the National Cardiovascular Data Registry CathPCI Registry.

Dr. Sukul and his colleagues limited their analysis to hospitals that both participated in that registry and performed at least 400 PCIs during July 2014–June 2015. That narrowed it down to 654 hospitals, including 44 out of the 50 hospitals ranked by U.S. News & World Report in 2015.

A total of 509,153 PCIs were performed over the 1-year study period, including 55,550 (10.9%) performed at the top-ranked hospitals.

After adjusting for patient risk, there was no difference in post-PCI in-hospital mortality between top-ranked and nonranked hospitals investigators reported (adjusted odds ratio, 0.96; P = .64).

There were also no differences in acute kidney injury (adjusted OR, 1.10; P = .1) or bleeding (adjusted OR, 1.15; P = .052) for top-ranked vs. nonranked hospitals, according to investigators.

In addition, top-ranked hospitals had a “slightly lower proportion” of appropriate PCI, Dr. Sukul reported.

Though rates of appropriate PCI were relatively high in both groups, odds of appropriate PCI were nevertheless significantly higher at nonranked hospitals (89.2% for ranked and 92.8% for nonranked hospitals; P less than .001).

Appropriate PCIs – those based on evidence-based indications – have been increasingly emphasized over the past decade.

Although some recent reports suggest hospital-level appropriateness may not necessarily correlate with clinical outcomes, Dr. Sukul remarked, “we believe that PCI appropriateness is an important indicator of quality, serving as a measure of physician decision-making when faced with treating the vast array of coronary artery disease presentations.”

Dr. Sukul is supported by a National Institutes of Health postdoctoral research training grant.

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