Author + information
- Received August 22, 2017
- Revision received October 24, 2017
- Accepted October 26, 2017
- Published online February 19, 2018.
- Devraj Sukul, MD, MSca,
- Deepak L. Bhatt, MD, MPHb,
- Milan Seth, MSa,
- Pearl Zakroysky, MPHc,
- Daniel Wojdyla, MScc,
- John S. Rumsfeld, MD, PhDd,
- Tracy Wang, MD, MHS, MScc,
- Sunil V. Rao, MDc and
- Hitinder S. Gurm, MDa,e,∗ ()
- aDepartment of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
- bBrigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
- cDuke Clinical Research Institute, Durham, North Carolina
- dDepartment of Internal Medicine, Division of Cardiology, University of Colorado School of Medicine, Denver, Colorado
- eDivision of Cardiovascular Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- ↵∗Address for correspondence:
Dr. Hitinder S. Gurm, 2A 394, 1500 East Medical Center Drive, University of Michigan Cardiovascular Center, Ann Arbor, Michigan 48109-5853.
Objectives This study sought to compare the appropriate use and outcomes of percutaneous coronary intervention (PCI) between top-ranked and nonranked hospitals.
Background The U.S. News & World Report “Best Hospitals” rankings are an influential consumer-directed publication of hospital quality, and are commonly used in promotional campaigns by hospital systems.
Methods Hospitals in the National Cardiovascular Data Registry CathPCI registry between July 1, 2014, and June 30, 2015, were classified as top-ranked if they were included in the 2015 U.S. News & World Report 50 best “Cardiology and Heart Surgery” hospitals. The remaining were classified as nonranked. We compared in-hospital mortality, post-procedural bleeding, post-procedural acute kidney injury, and the proportion of appropriate PCI procedures between top-ranked and nonranked hospitals.
Results A total of 509,153 PCIs at 654 hospitals were included, of which 55,550 (10.9%) were performed at 44 top-ranked hospitals. After adjusting for patient case mix, PCIs performed at top-ranked hospitals had similar odds of in-hospital mortality (adjusted odds ratio [aOR]: 0.96; 95% confidence interval [CI]: 0.83 to 1.12; p = 0.64), acute kidney injury (aOR: 1.10; 95% CI: 0.98 to 1.22; p = 0.099), and bleeding (aOR: 1.15; 95% CI: 0.99 to 1.31; p = 0.052). Top-ranked hospitals had a slightly lower proportion of appropriate PCI compared with nonranked hospitals (89.2% vs. 92.8%; OR: 0.56; 95% CI: 0.45 to 0.69; p < 0.001).
Conclusions PCI performed at top-ranked hospitals was not associated with superior outcomes compared with PCI at nonranked hospitals. The inclusion of metrics based on clinical data may be important for hospital quality rankings.
Dr. Sukul was supported by a National Institutes of Health T32 postdoctoral research training grant (T32-HL007853). Dr. Bhatt has served on the advisory board for Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, and Regado Biosciences; has served on the Board of Directors of the Boston VA Research Institute and Society of Cardiovascular Patient Care; has served as the chair of American Heart Association Quality Oversight Committee; has served on the data monitoring committees of the Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, and Population Health Research Institute; has received honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), J Am Coll Cardiol (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME steering committees); has served as the Deputy Editor for Clinical Cardiology; has served as the chair of the NCDR-ACTION Registry Steering Committee and VA CART Research and Publications Committee; has received research funding from Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald Heart Disease); has served as a site co-investigator for Biotronik, Boston Scientific, and St. Jude Medical (now Abbott); has served as a trustee of American College of Cardiology; and has performed unfunded research for FlowCo, PLx Pharma, and Takeda. Dr. Rumsfeld is Chief Innovation Officer for the American College of Cardiology. Dr. Wang has received institutional research grant support to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead Sciences, Pfizer, and Regeneron Pharmaceuticals; and received consulting or honoraria from Gilead, Merck, and Sanofi. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 22, 2017.
- Revision received October 24, 2017.
- Accepted October 26, 2017.
- 2018 American College of Cardiology Foundation