Risk scores do not adjust for aggressive, evidence-based changes in percutaneous coronary intervention practice patterns

Steven E.S. Miner, Lynne E. Nield, Sylvain Plante, Lorne Goldman, Manu Prabhakar, Karen Elliott, Cedric Manlhiot, Brian W. Mccrindle

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)137-146
Number of pages10
JournalFuture Cardiology
Volume11
Issue number2
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

Keywords

  • behavioral sciences
  • health policy
  • mortality
  • percutaneous coronary intervention
  • risk scores

ASJC Scopus subject areas

  • Molecular Medicine
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Miner, S. E. S., Nield, L. E., Plante, S., Goldman, L., Prabhakar, M., Elliott, K., Manlhiot, C., & Mccrindle, B. W. (2015). Risk scores do not adjust for aggressive, evidence-based changes in percutaneous coronary intervention practice patterns. Future Cardiology, 11(2), 137-146. https://doi.org/10.2217/fca.15.7