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REVIEW AND COMMENTARY

The Public Health Hazards of Risk Avoidance Associated With Public Reporting of Risk-Adjusted Outcomes in Coronary Intervention

Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts

Manuscript received March 27, 2008; revised manuscript received October 1, 2008, accepted November 24, 2008.

^_* Reprint requests and correspondence: Dr. Frederic S. Resnic, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115 (Email: fresnic{at}partners.org).

Public reporting of risk-adjusted outcomes for percutaneous coronary intervention (PCI) procedures has been mandated in New York State for more than a decade. During that time there has been a significant decline in the unadjusted mortality after such procedures. Massachusetts joined New York in 2003 as only the second state to require case level reporting of every coronary interventional procedure performed. In this review, we explore the differences in the populations reported by the 2 states and consider possible risks of public reporting of clinical outcomes after PCI procedures, including the risk of increasing conservatism in the treatment of the sickest patients. We offer a conceptual framework to understand the potential risk-averse behavior of interventional cardiologists subject to public reporting, and offer several proposals to counteract this potential deleterious effect of reporting programs.

Key Words: percutaneous coronary intervention • quality assurance • cardiogenic shock

Abbreviations and Acronyms   CABG = coronary artery bypass grafting   PCI = percutaneous coronary intervention   STEMI = ST-elevation myocardial infarction

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