In:
Circulation: Cardiovascular Quality and Outcomes, Ovid Technologies (Wolters Kluwer Health), Vol. 13, No. Suppl_1 ( 2020-05)
Abstract:
Background: For patients presenting with ST segment elevation myocardial infarction (STEMI), shorter door-to-balloon (D2B) times are associated with lower mortality, and national quality improvement initiatives encourage hospitals to reduce D2B time to ≤90 minutes. Hospitals can exclude patients from public reporting for various non-system reasons. This raises the possibility that cases with D2B time marginally over 90 minutes may be excluded inappropriately to avoid detrimental effects of not meeting the cutoff. Methods: All adult patients with STEMI undergoing primary PCI in 2011-2018 in Washington State were identified from the Cardiac Care Outcomes Assessment Program, a statewide public reporting program. We compared the proportion of cases excluded from public reporting above and below the 90-minute D2B cutoff using Chi-Square analysis. We then plotted histograms of frequency of cases by D2B time and used a regression discontinuity framework to test for a discontinuity in the frequency of reported cases at 90 minutes, with a sharp cutoff at 90 minutes and 5-minute bandwidth around the cutoff. Findings: Of 19,348 patients, 7,436 (38.4%) were excluded from the D2B metric. Among patients with D2B time 85-90 minutes, 47.9% (477/996) were excluded, versus 54.4% (345/634) of patients with D2B time 90-95 minutes (p 〈 0.01). Patient and procedural characteristics were similar for those with D2B time 85-90 versus 90-95 minutes. After application of exclusion criteria, there appeared to be a visible discontinuity in the distribution of cases around 90 minutes (Figure). However, local quadratic regression with bandwidths of 5 minutes above and below the 90-minute cutoff did not find a significant discontinuity (p = 0.66). Conclusions: Among patients undergoing primary PCI for STEMI in Washington State, a higher proportion of patients with D2B time of 90-95 minutes were excluded from public reporting compared with 85-90 minutes; however, there was no evidence of a discontinuity in the frequency of reported cases around the 90-minute cutoff. Together, these findings suggest that although more patients are excluded above the cutoff, there is no evidence of systemic manipulation or inappropriate exclusion of cases near the cutoff. Figure: An overlaid distribution centered at 90 minutes of included and excluded cases
Type of Medium:
Online Resource
ISSN:
1941-7713
,
1941-7705
DOI:
10.1161/hcq.13.suppl_1.259
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2020
detail.hit.zdb_id:
2453882-6
Permalink