Author + information
- Received August 22, 2017
- Revision received October 24, 2017
- Accepted October 26, 2017
- Published online November 12, 2017.
- Devraj Sukul, MD1,
- Deepak L. Bhatt, MD, MPH2,
- Milan Seth, MS1,
- Pearl Zakroysky, MPH3,
- Daniel Wojdyla, MSc3,
- John S. Rumsfeld, MD, PhD4,
- Tracy Wang, MD, MHS, MSc3,
- Sunil V. Rao, MD3 and
- Hitinder S. Gurm, MD1,5,∗ ()
- 1Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
- 2Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts
- 3Duke Clinical Research Institute, Durham, North Carolina
- 4University of Colorado School of Medicine, Denver, Colorado
- 5Cardiovascular Medicine, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- ↵∗Correspondence to: Hitinder S. Gurm, MD 2A 394 1500 East Medical Ctr Drive, University of Michigan Cardiovascular Center Ann Arbor, MI 48109-5853.
Background The U.S. News & World Report’s “Best Hospitals” rankings are an influential consumer-directed publication of hospital quality, and are commonly used in promotional campaigns by hospital systems.
Objectives To compare the appropriate use and outcomes of percutaneous coronary intervention (PCI) between top-ranked and non-ranked hospitals.
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’s 50 best “Cardiology and Heart Surgery” hospitals. The remaining were classified as non-ranked. We compared in-hospital mortality, post-procedural bleeding, post-procedural acute kidney injury (AKI), and the proportion of appropriate PCI procedures between top-ranked and non-ranked 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] 0.83–1.12; P=0.64), AKI (aOR 1.10; 95% CI 0.98–1.22; P=0.099), and bleeding (aOR: 1.15; 95% CI 0.999–1.31; P=0.052). Top-ranked hospitals had a slightly lower proportion of appropriate PCI compared with non-ranked hospitals (89.2% versus 92.8%; OR: 0.56; 95% CI: 0.45-0.69; P<0.001).
Conclusion PCI performed at top-ranked hospitals was not associated with superior outcomes compared with PCI at non-ranked hospitals. The inclusion of metrics based on clinical data may be important for hospital quality rankings.
Dr. Sukul is supported by the National Institutes of Health T32 postdoctoral research training grant (T32-HL007853).
Devraj Sukul reports no relevant disclosures.
Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; Honoraria: 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), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical; Trustee: American College of Cardiology; Unfunded Research: FlowCo, PLx Pharma, Takeda.
Milan Seth reports no relevant disclosures.
Pearl Zakroysky reports no relevant disclosures.
Daniel Wojdyla reports no relevant disclosures.
John S. Rumsfeld is Chief Innovation Officer for the American College of Cardiology.
Tracy Wang reports research grants to the Duke Clinical Research Institute from AstraZeneca, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead Sciences, Pfizer, and Regeneron Pharmaceuticals, as well as consulting or honoraria from Gilead, Merck, and Sanofi.
Sunil V. Rao reports no relevant disclosures.
Hitinder S. Gurm reports no relevant disclosures.
- Received August 22, 2017.
- Revision received October 24, 2017.
- Accepted October 26, 2017.