Jacob V. Spertus, Sharon-Lise T. Normand, Robert Wolf, Matt Cioffi, Ann Lovett and Sherri Rose. Although risk adjustment remains a cornerstone for comparing outcomes across hospitals, optimal strategies continue to evolve in the presence of many confounders. We compared conventional regression-based model to approaches particularly suited to leveraging big data.
Massachusetts Department of Public Health approves public reporting of PCI hospital risk-standardized 30-day mortality for fiscal year 2015. Mass-DAC participating PCI programs must collect 30-day follow-up information for all non-Massachusetts residents receiving a PCI on October 1, 2014, or later. Additional details on the new Mass-DAC specifications are available on the Data Manager – Data Submisssions – PCI Data page and in the data submission supplemental demographic file specifications.
Abdallah K. Alameddine, Paul Visintainer, Sharon-Lise T Normand, et. al. The postprocedural state after cardiac revascularization interventions is characterized by intense inflammation and activation of inflammatory cytokines due to myonecrosis and ischemia/reperfusion injury. Involvement of similar processes also participates in cellular malignant transformation. Undergoing heart revascularization procedures was associated with increased rate of cancer development as compared with the state general population.
Sripal Bangalore, Treacy S. Silbaugh, Sharon-Lise T. Normand, et. al. The safety of drug-eluting stents (DES) vs. bare metal stents (BMS) in the perioperative setting, a heightened state of inflammation and thrombosis is not well defined. DES implantation was not associated with higher adverse events after NCS. Moreover, the incidence of adverse events following NCS was lower when NCS was performed >90 days post-DES implantation suggesting that it may not be necessary to wait until 12 months post PCI with DES before NCS.
Early Results of Massachusetts Health Care Reform on Racial, Ethnic and Socioeconomic Disparities in Cardiovascular Care
Michelle A. Albert, John Z. Ayanian, Treacy S. Silbaugh, et. al. Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex. We found that reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in access to these procedures.
Jason H. Wasfy, Jordan B. Strom, et. al. Rehospitalization within 30 days after an admission for percutaneous coronary intervention (PCI) is common, costly, and a future target for Medicare penalties. Causes of readmission after PCI are largely unknown. It was found that readmissions within 30 days were seldom related to PCI complications but often for recurrent chest pain.
The Massachusetts Department of Public Health will begin transitioning toward the public reporting of hospital risk-standardized 30-day mortality for PCIs during the coming year. The transition will occur in phases and will require hospitals to collect new variables for 30-day mortality status beginning with procedures occurring October 1, 2014 or later. Additional details on the new Mass-DAC specifications […]
Robert W. Yeh, Samip Vasaiwala, et. al. Evaluating novel therapies is challenging in the extremely elderly. Using an instrumental variable analysis, DES were associated with similar mortality and bleeding and a significant reduction in target vessel revascularization compared with bare metal stents in the extremely elderly. Variation in use rates may be useful as an instrumental variable to facilitate comparative effectiveness in groups underrepresented in randomized trials.
A Prediction Model to Identify Patients at High Risk for 30-Day Readmission After Percutaneous Coronary Intervention
Jason H. Wasfy, Kenneth Rosenfield, et. al. Background: The Affordable Care Act creates financial incentives for hospitals to minimize readmissions shortly after discharge for several conditions, with percutaneous coronary intervention (PCI) to be a target in 2015. We aimed to develop and validate prediction models to assist clinicians and hospitals in identifying patients at highest risk for 30-day readmission after PCI. The risk calculator for this paper is available under the Public Outreach-Risk Calculator menu.
Alice K. Jacobs M.D., Sharon-Lise T. Normand, Ph.D., et al. – Background: Emergency surgery has become a rare event after percutaneous coronary intervention (PCI). Whether having cardiac-surgery services available on-site is essential for ensuring the best possible outcomes during and after PCI remains uncertain.