Risk scores do not adjust for aggressive, evidence-based changes in percutaneous coronary intervention practice patterns
| Autor: | Brian W. McCrindle, Manu Prabhakar, Sylvain Plante, Karen Elliott, Steven E.S. Miner, Cedric Manlhiot, Lorne Goldman, Lynne E. Nield |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Evidence-based practice medicine.medical_treatment Myocardial Infarction Behavioural sciences Risk Assessment Cohort Studies Percutaneous Coronary Intervention Clinical Protocols Outcome Assessment Health Care medicine Humans Hospital Mortality Practice Patterns Physicians' Health policy Aged Framingham Risk Score Practice patterns business.industry Patient Selection Percutaneous coronary intervention Middle Aged Cohort Emergency medicine Conventional PCI Physical therapy Molecular Medicine Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Future Cardiology. 11:137-146 |
| ISSN: | 1744-8298 1479-6678 |
| DOI: | 10.2217/fca.15.7 |
| Popis: | ABSTRACT Aim: Public reporting of procedural outcomes leads to risk averse behavior because physicians do not believe the scores account for patient risk. We investigated the effects of more aggressive percutaneous coronary intervention (PCI) practice on risk-adjusted mortality. Methods & results: 8935 PCI were performed. Risk adjustment was performed with the New York State PCI risk score. The cohort was divided into two eras based on programs implemented to promote more aggressive care. Between eras, overall adjusted mortality ratios rose from 0.66 to 0.90 (observed/predicted, p = 0.02), despite evidence supporting consistent procedural quality. Conclusion: Evidence-based changes in PCI practice were associated with worsening risk-adjusted procedural mortality. These data are consistent with physician beliefs regarding risk-adjusted outcome measures. |
| Databáze: | OpenAIRE |
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