Faster heart-attack treatment times don't mean lower mortality

Even though hospitals are performing primary percutaneous coronary intervention (PCI) on heart attack patients faster, in-hospital and 30-day mortality for these patients have not improved, according to a study in today's New England Journal of Medicine.

Looking at door-to-balloon times and in-hospital mortality for 96,738 admissions at 515 hospitals participating in the CathPCI Registry, researchers found the median hospital door-to-balloon time fell to 67 minutes in 2009 from 83 minutes in 2005.

But despite faster heart-attack treatment times, hospitals saw no significant change for unadjusted in-hospital or unadjusted 30-day mortality rates.

The Centers for Medicare & Medicaid Services has been publicly reporting hospital performance on door-to-balloon times for heart attack patients undergoing PCI since 2005, according to AHA News Now.

As the study suggests, national efforts to improve door-to-balloon times won't guarantee lower mortality rates.

Meanwhile, outlier hospitals in Massachusetts appear to be avoiding PCI for high-risk patients to reduce their publicly reported mortality rates, according to a study in the June issue of JACC: Cardiovascular Interventions. Researchers found risk-aversive behaviors among PCI operators at outlier hospitals may be a consequence of public reporting.

U.S. hospitals perform more than 600,000 PCI procedures annually, according to the American College of Cardiology , and about one in seven of those patients are readmitted within 30 days. Not surprisingly, Medicare's Hospital Compare website now includes data on PCI readmission rates.

For more:
- here's the AHA News Now brief
- check out the NEJM article

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