Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (A.S.N., S.A.K., J.G.).
Leonard Davis Institute of Health Economics (A.S.N., S.A.K., E.D., P.C., N.D.D., P.W.G., J.G.), University of Pennsylvania, Philadelphia, PA.
Circ Cardiovasc Interv. 2019 Apr;12(4):e007564. doi: 10.1161/CIRCINTERVENTIONS.118.007564.
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.
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).
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.
心血管结局的公开报告与潜在救生程序的风险规避有关，并且可能对未报告但相关的程序产生溢出效应。
使用全国住院患者样本，对 2005 年至 2011 年期间在有经皮冠状动脉介入术（PCI）结果公开报告的州（纽约州和马萨诸塞州）与没有经皮冠状动脉介入术结果公开报告的州（特拉华州、康涅狄格州、缅因州、佛蒙特州、马里兰州和罗得岛州）发生院外心脏骤停的患者中进行了冠状动脉造影的使用情况进行了横断面分析。我们分析了 2005 年至 2011 年间 50125 例发生院外心脏骤停的入院记录。有公开报告与没有公开报告的州中，院外心脏骤停患者的冠状动脉造影率未经调整时无差异（20.8%比 22.8%，P=0.35）。虽然点估计提示使用率降低，但我们发现有公开报告的州中冠状动脉造影的调整后可能性无统计学差异（比值比，0.84；95%置信区间，0.66-1.06；P=0.14）。有公开报告的州与没有公开报告的州相比，院外心脏骤停患者的院内死亡率调整后可能性无差异（比值比，0.98；95%置信区间，0.78-1.23；P=0.88）。
经皮冠状动脉介入术结果的公开报告与诊断性冠状动脉造影使用率的非统计学显著降低相关，而后者是一种未报告但相关的程序，适用于院外心脏骤停患者。
