title: Rates of Invasive Management of Cardiogenic Shock in New York Before and After Exclusion From Public Reporting.
abstract: Reduced rates of cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) are an unintended consequence of public reporting of cardiogenic shock outcomes in New York.
  
  
  
  To evaluate whether the referral rates for cardiac catheterization, PCI, or CABG have improved in New York since cardiogenic shock was excluded from public reporting in 2008 and compare them with corresponding rates in Michigan, New Jersey, and California.
  
  
  
  Patients with cardiogenic shock complicating acute myocardial infarction from 2002 to 2011 were identified using the National Inpatient Sample. Propensity score matching was used to assemble a cohort of patients with cardiogenic shock with similar baseline characteristics in New York and Michigan.
  
  
  
  Percutaneous coronary intervention (primary outcome), invasive management (cardiac catheterization, PCI, or CABG), revascularization (PCI or CABG), and CABG were evaluated with reference to 3 calendar year periods: 2002-2005 (time 1: cardiogenic shock included in publicly reported outcomes), 2006-2007 (time 2: cardiogenic shock excluded on a trial basis), and 2008 and thereafter (time 3: cardiogenic shock excluded permanently) in New York and compared with Michigan.
  
  
  
  Among 2126 propensity score-matched patients representing 10 795 (weighted) patients with myocardial infarction complicated by cardiogenic shock in New York and Michigan, 905 (42.6%) were women and mean (SE) age was 69.5 (0.3) years. A significantly higher proportion of the patients underwent PCI (time 1 vs 2 vs 3: 31.1% vs 39.8% vs 40.7% [OR, 1.50; 95% CI, 1.12-2.01; P = .005 for time 3 vs 1]), invasive management (time 1 vs 2 vs 3: 59.7% vs 70.9% vs 73.8% [OR, 1.84; 95% CI, 1.37-2.47; P < .001 for time 3 vs 1]), or revascularization (43.1% vs 55.9% vs 56.3% [OR, 1.66; 95% CI, 1.26-2.20; P < .001 for time 3 vs 1]) after the exclusion of cardiogenic shock from public reporting in New York. However, during the same periods, a greater proportion of patients underwent PCI (time 1 vs 2 vs 3: 41.2% vs 52.6% vs 57.8% [OR, 1.93; 95% CI, 1.45-2.56; P < .001 for time 3 vs 1]), invasive management (time 1 vs 2 vs 3: 64.4% vs 80.5% vs 78.6% [OR, 2.01; 95% CI, 1.47-2.74; P < .001 for time 3 vs 1]), or revascularization (51.2% vs 65.8% vs 68.0% [OR, 2.00; 95% CI, 1.50-2.66; P < .001 for times 3 vs 1]) in Michigan. Results were largely similar in several sensitivity analyses comparing New York with New Jersey or California.
  
  
  
  Although the rates of PCI, invasive management, and revascularization have increased substantially after the exclusion of cardiogenic shock from public reporting in New York, these rates remain consistently lower than those observed in other states without public reporting.
authors.affiliation: Department of Medicine, Division of Cardiology, New York University School of Medicine, New York.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: Department of Statistics, New York University School of Medicine, New York.
authors.forename: Yu
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam, Hong Kong.
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Population Health, New York University School of Medicine, New York.
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Medicine, Division of Cardiology, New York University School of Medicine, New York.
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
authors.affiliation: Department of Medicine, Division of Cardiology, New York University School of Medicine, New York.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D002140:California; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D019221:Mandatory Reporting; D008824:Michigan; D009515:New Jersey; D009518:New York; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D012770:Shock, Cardiogenic / Q000628:therapy*; D016896:Treatment Outcome