Excluding high-risk cardiac patients from public reporting improves outcomes

Editor's Note

Public reporting may discourage physicians from offering lifesaving treatment to patients who are at the greatest risk for mortality and poor outcomes, this study finds.

Of 45,000 cardiac patients analyzed, the researchers found that physicians were 28% more likely to perform percutaneous coronary interventions (PCI) on patients who had severe heart attacks complicated by life-threatening cardiogenic shock after these patients were excluded from public reporting criteria. The researchers also found a significant 24% decrease in mortality among these patients.

In 1992, New York was the first state to publicly report mortality outcomes after PCI. In 2006, on the basis of concerns that physicians were not treating patients in order to avoid risk, the New York Department of Public Health changed its policy and began excluding patients with cardiogenic shock from the publicly reported PCI risk-adjusted mortality analyses. 

Importance In 2006, New York began excluding patients with cardiogenic shock from the publicly reported percutaneous coronary intervention (PCI) risk-adjusted mortality analyses. Objective To examine the effects of the New York shock-exclusion policy change on rates of revascularization and mortality for patients with acute myocardial infarction (AMI) complicated by cardiogenic shock.