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Some Doctors Avoid Heart Procedure for Risky Patients

They cite published mortality 'report cards' as an influence, study finds

MONDAY, Jan. 10, 2005 (HealthDayNews) -- Some heart doctors may avoid performing a lifesaving procedure in certain patients lest the patient die and influence their mortality "report card," a new study finds.

The majority of interventional cardiologists practicing in New York state said knowing such statistics are collected and published influenced their decision on whether to perform risky yet essential angioplasty in certain situations.

"I was really struck by the high number of physicians who admitted that they take this mortality reporting system into account when they were trying to make a decision about whether to treat an individual or not," said Dr. Craig Narins, lead author of the study that appears in the Jan. 10 issue of the Archives of Internal Medicine.

"No physician would say outright, 'I'm not going to do it because it may look bad,' but it may, in the back of their mind, enter into the decision-making process," added Narins, a practicing interventional cardiologist at the University of Rochester School of Medicine.

Narins and his colleagues sent anonymous, one-page questionnaires to all interventional cardiologists who were included in New York state's most recent angioplasty report. Of 186 physicians who received the survey, 120 -- or 65 percent -- responded.

The doctors were asked to say whether they strongly agreed, agreed, disagreed or strongly disagreed with each of nine statements.

Seventy-nine percent of the respondents agreed or strongly agreed that, in certain instances, the publication of mortality statistics influenced their decision whether or not to perform angioplasty on specific patients. At the same time, 83 percent agreed or strongly agreed that individuals who might benefit from the procedure may not receive it because of this public reporting system. Angioplasty is a procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart.

The New York state Department of Health has, since 1992, collected and published patient mortality statistics for all surgeons in the state who perform coronary artery bypass surgery and for all interventional cardiologists who perform coronary angioplasty.

In addition to New York, Pennsylvania also compiles physician "scorecards," Narins said. There may be one or two other states but Narins has, as of yet, been unable to identify them.

"The basic premise of this New York state reporting system is to help the public make more informed decisions about which doctors they should seek out and to increase quality of care," Narins said. "The thinking is that if the statistics are going to be published, doctors will make every effort to improve them."

The question that had not been answered -- and Narins sought to do so -- was whether this system had any influence on how physicians cared for their patients.

William Van Slyke, deputy commissioner for the New York state Department of Health, said, "I'm confident that the vast majority of surgeons are basing their medical procedure decisions on what's best for patients in consultation with their patients. This survey more likely reflects the simple fact that 79 percent of surgeons indicated that they had avoided a procedure that carried too great a risk to their patients. That's a judgment call that physicians make every day. We certainly support those decisions."

Dr. Samin Sharma, director of interventional cardiology at Mount Sinai Medical Center in New York City, felt that low-volume centers were more likely to decline cases than were high-volume centers.

Narins is not suggesting throwing out the system.

"I think there is some useful information that can be gained," he said. "If the hospital mortality rate is way off the scale, it should be brought to attention."

But certain refinements, such as separating out elective surgeries from patients who are extremely ill, might help, he added.

More information

To learn more about angioplasty, visit the National Library of Medicine.

SOURCES: Craig Narins, M.D., assistant professor, medicine, University of Rochester School of Medicine, Rochester, N.Y.; Samin Sharma, M.D., director, interventional cardiology, Mount Sinai Medical Center, New York City; William Van Slyke, deputy commissioner, New York state Department of Health; Jan. 10, 2005, Archives of Internal Medicine
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