Association between Public Reporting of Outcomes and the Use of Mechanical Circulatory Support in Patients with Cardiogenic Shock

Abstract EN

Risk-averse behavior has been reported among physicians and facilities treating cardiogenic shock in states with public reporting.

Our objective was to evaluate if public reporting leads to a lower use of mechanical circulatory support in cardiogenic shock.

We conducted a retrospective study with the use of the National Inpatient Sample from 2005 to 2011.

Hospitalizations of patients ≥18 years old with a diagnosis of cardiogenic shock were included.

A regional comparison was performed to identify differences between reporting and nonreporting states.

The main outcome of interest was the use of mechanical circulatory support.

A total of 13043 hospitalizations for cardiogenic shock were identified of which 9664 occurred in reporting and 3379 in nonreporting states (age 69.9 ± 0.4 years, 56.8% men).

Use of mechanical circulatory support was 32.8% in this high-risk population.

Odds of receiving mechanical circulatory support were lower (OR 0.50; 95% CI 0.43–0.57; p<0.01) and in-hospital mortality higher (OR 1.19; 95% CI 1.06–1.34; p<0.01) in reporting states.

Use of mechanical circulatory support was also lower in the subgroup of patients with acute myocardial infarction and cardiogenic shock in reporting states (OR 0.61; 95% CI 0.51–0.72; p<0.01).

In conclusion, patients with cardiogenic shock in reporting states are less likely to receive mechanical circulatory support than patients in nonreporting states.