18th Oct 2012 by 
“According to a new study, patients who suffer from heart attacks in states which report the results of procedures that open up blocked arteries will be less likely to receive life-saving treatments. On the other hand, the study shows that patients that live in states which do not require these results to be published are more likely to receive these treatments. However, the discrepancies between health care levels only have a small impact on the survival rate of patients. The study was published in the Journal of the American Medical Association, this Wednesday.
The study analysis was based on approximately 100,000 patients from 10 different states, all of which were insured by Medicare. This study also supports the nationwide progress towards a greater level of transparency between health care provided by different hospitals and doctors.
Health care policy experts agree that publishing the results of such procedures is in the benefit of patients. Publishing these results would allow the patient to get informed on the results of each hospital and to opt for the best one, in order to receive the best care. However, the current study also shows that the publication of these results does not necessary lead to a good outcome.
According to Dr Hitinder Gurm, who had no involvement in the analysis, due to this particular study, several doctors refused to treat patients who were extremely sick, being concerned and pressured to keep their high success rates. He noted that, “The study highlights the unintended consequences of public reporting”. On the other hand, Dr Gurm said that another reason that causes these discrepancies between hospitals could be the fact that doctors were able to steer clear of critical cases. The lead author of the study, Dr Karen Joynt, from the Brigham and Women’s Hospital, from Boston, concluded that both theories are probably correct.
Dr Joynt recalls that the rumors she heard among cardiologists from Massachusetts, saying that doctors weren’t conducting any life-saving procedures on patients with a low chance of survival, convinced her to start this analysis. Her research team studied Medicare data gathered throughout the past 9 years from patients over the age of 65, with at least one acute heart attack in their medical history.
The most recent data analyzed, dating from 2010, shows that almost 38% of patients from Massachusetts, Pennsylvania and New York required an artery-opening procedure. These states all require that hospitals make their reports available to the open public. The results from the 7 other states that took part in the analysis (Maine, Connecticut, Delaware, Maryland, Vermont, New Hampshire and Rhode Island) showed that this percentage went up to almost 43%. An even greater discrepancy was revealed among patients with full artery blockage: only 62% in the first 3 states, compared to 68% in the rest of the 7 states.
Dr Joynt says that sometimes, the decision of whether to intervene or not in a critical patient, is a very tough decision. Most of the patients who suffer from an acute heart attack arrive in critical condition at the hospital, having already only a small chance of survival, even if the correct procedures are followed. The most common procedure that leads to the unblocking of the arteries is stenting. This procedure involves the insertion of a balloon catheter in the coronary artery that was occluded. Upon reaching the destination of the stent, the balloon expands, fixing the stent on the walls of the blood vessel.
The research team showed that the general death rates of patients who suffered from an acute heart attack is approximately 12% after 30 days from the incident. The analysis of the death rate coming from the first 3 states showed a death rate of 13.5% for patients suffering from fully occluded arteries. In comparison, the death rate reported from the other 7 states was 11%. The difference is statistically significant.
Public reporting has been used for a long time in transplant surgery. Its main purpose is to act as a safeguard against the waste of donor organs, which are already very few. Recently, public reporting has spread to other medical domains. This data is published by Medicare on www.hospitalcompare.hhs.gov.
According to researchers, their study might be used by doctors who already showed opposition to public reporting to support their cause. However, more experts suggest that not only is this study beneficial to the health care domain, but it also emphasizes the fact that a more complex method of measurement is needed. A better method would ensure that the differences between patients are also taken into consideration, thus allowing a more accurate comparison.
Dr Harlan Krumholz, a cardiologist from Yale is one of the researchers responsible for the development of the outcome measure that was used by Medicare. He said that further investigation is required, commending that the cause of these discrepancies between different hospitals or different doctors must be investigated in order to improve the health care system.
“Just putting the data online is not enough”, Dr Krumholz concluded.
About Author: Riciu Andrei is a 6th year medical student and founder of Doctor Tipster. He is passionate about the Internet and the health niche. Doctor Tipster is currently his full-time business. He dedicates his time keeping the site up and running and reading about the latest medical discoveries as soon as they are made public. He believes that everyone who is sick deserves the best possible medical treatment and wants to pursue a career in the Ophthalmology research field. He can be reached at [email protected].
