Dataset Information

Effect of Public Reporting on the Utilization of Coronary Angiography After Out-of-Hospital Cardiac Arrest.

ABSTRACT:

Background

Public reporting of cardiovascular outcomes has been associated with risk aversion for potentially lifesaving procedures and may have spillover effects on nonreported but related procedures.

Methods and results

A cross-sectional analysis of the utilization of coronary angiography among patients presenting with out-of-hospital cardiac arrest between 2005 and 2011 in states with public reporting of percutaneous coronary intervention outcomes (New York and Massachusetts) versus neighboring states without public reporting of percutaneous coronary intervention outcomes (Delaware, Connecticut, Maine, Vermont, Maryland, and Rhode Island) was performed using the Nationwide Inpatient Sample. We analyzed 50 125 admission records with out-of-hospital cardiac arrest between 2005 and 2011. The unadjusted rate of coronary angiography for patients presenting with out-of-hospital cardiac arrest in states with public reporting versus without public reporting was not different (20.8% versus 22.8%, P=0.35). We found no statistically significant difference in the adjusted likelihood of coronary angiography in states with public reporting, though the point estimate suggested decreased utilization (odds ratio, 0.84; 95% CI, 0.66-1.06; P=0.14). There was no difference in the adjusted likelihood of in-hospital mortality for patients presenting with out-of-hospital cardiac arrest in states with public reporting compared to states without public reporting (odds ratio, 0.98; 95% CI, 0.78-1.23; P=0.88).

Conclusions

Public reporting of percutaneous coronary intervention outcomes was associated with a nonstatistically significant reduction in the utilization of diagnostic coronary angiography, a nonreported but related procedure, for patients with out-of-hospital cardiac arrest.

SUBMITTER: Nathan AS

PROVIDER: S-EPMC9123930 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

Effect of Public Reporting on the Utilization of Coronary Angiography After Out-of-Hospital Cardiac Arrest.

Nathan Ashwin S AS Shah Rohan M RM Khatana Sameed A SA Dayoub Elias E Chatterjee Paula P Desai Nimesh D ND Waldo Stephen W SW Yeh Robert W RW Groeneveld Peter W PW Giri Jay J

Circulation. Cardiovascular interventions 20190401 4

<h4>Background</h4>Public reporting of cardiovascular outcomes has been associated with risk aversion for potentially lifesaving procedures and may have spillover effects on nonreported but related procedures.<h4>Methods and results</h4>A cross-sectional analysis of the utilization of coronary angiography among patients presenting with out-of-hospital cardiac arrest between 2005 and 2011 in states with public reporting of percutaneous coronary intervention outcomes (New York and Massachusetts) v ...[more]

PMID: 30998398

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Project description:ImportanceMyocardial infarction is a frequent cause of out-of-hospital cardiac arrest (OHCA). The long-term effect of early coronary angiography on patients with OHCA with possible coronary trigger but no ST-segment elevation remains unclear.ObjectiveTo compare the clinical outcomes of early unselective angiography with the clinical outcomes of a delayed or selective approach for successfully resuscitated patients with OHCA of presumed cardiac origin without ST-segment elevation at 1-year follow-up.Design, setting, and participantsThe TOMAHAWK trial was a multicenter, international (Germany and Denmark), investigator-initiated, open-label, randomized clinical trial enrolling 554 patients between November 23, 2016, to September 20, 2019. Patients with stable return of spontaneous circulation after OHCA of presumed cardiac origin but without ST-segment elevation on the postresuscitation electrocardiogram were eligible for inclusion. A total of 554 patients were randomized to either immediate coronary angiography after hospital admission or an initial intensive care assessment with delayed or selective angiography after a minimum of 24 hours. All 554 patients were included in survival analyses during the follow-up period of 1 year. Secondary clinical outcomes were assessed only for participants alive at 1 year to account for the competing risk of death.InterventionsEarly vs delayed or selective coronary angiography and revascularization if indicated.Main outcomes and measuresEvaluations in this secondary analysis included all-cause mortality after 1 year, as well as severe neurologic deficit, myocardial infarction, and rehospitalization for congestive heart failure in survivors at 1 year.ResultsA total of 281 patients were randomized to the immediate angiography group and 273 to the delayed or selective group, with a median age of 70 years (IQR, 60-78 years). A total of 369 of 530 patients (69.6%) were male, and 268 of 483 patients (55.5%) had a shockable arrest rhythm. At 1 year, all-cause mortality was 60.8% (161 of 265) in the immediate angiography group and 54.3% (144 of 265) in the delayed or selective angiography group without significant difference between the treatment strategies, trending toward an increase in mortality with immediate angiography (hazard ratio, 1.25; 95% CI, 0.99-1.57; P = .05). For patients surviving until 1 year, the rates of severe neurologic deficit, myocardial infarction, and rehospitalization for congestive heart failure were similar between the groups.Conclusions and relevanceThis study found that a strategy of immediate coronary angiography does not provide clinical benefit compared with a delayed or selective invasive approach for patients 1 year after resuscitated OHCA of presumed coronary cause and without ST-segment elevation.Trial registrationClinicalTrials.gov Identifier: NCT02750462.

Dataset Information

Effect of Public Reporting on the Utilization of Coronary Angiography After Out-of-Hospital Cardiac Arrest.

Background

Methods and results

Conclusions

Publications

Effect of Public Reporting on the Utilization of Coronary Angiography After Out-of-Hospital Cardiac Arrest.

Similar Datasets

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