Public reporting of PCI operator outcomes

outcomes is believed by its proponents to facilitate transparency, incentivise high quality care and allow patients to make informed decisions in choosing healthcare providers. The existing evidence base for public reporting is predominantly derived from studies of North American patients who have undergone cardiac procedures, with systematic reviews and metaanalyses suggesting the impact of public reporting on clinical outcomes is mostly positive and may reduce mortality, although with a high degree of heterogeneity between studies that limits this interpretation [1, 2]. However, despite increasing enthusiasm for public reporting internationally, it remains a contentious issue. This is particularly the case with respect to public reporting of individual percutaneous coronary intervention (PCI) operator outcomes, with its critics highlighting both whether one is able to accurately risk adjust to make fair assessments but also that public reporting may lead to risk adverse behaviour by physicians [3] The latter criticism is supported by both indirect and direct evidence that public reporting of operator outcome influences interventional cardiologists’ decision to proceed to PCI. One study from the United States highlights, in a sample of over 80,000 patients admitted with acute myocardial infarction, that in states with public reporting the rates of PCI are lower than in those states without public reporting [4]. Of concern was that this effect was most pronounced in the patient groups (cardiogenic shock, arrest) with potentially the most to benefit from urgent revascularisation [4]. After patients with cardiogenic shock were excluded from public reporting in New York there was a significant increase in the rates of PCI in shock with a corresponding decrease in in-hospital mortality [5]. Furthermore, in a survey of interventional cardiologists from New York and Massachusetts almost twothirds of respondents admitted avoiding PCI on at least two occasions because of concerns that a bad outcome would negatively impact their publicly reported outcomes [6]. There is also concern that the practice of public reporting of PCI outcomes imposes a significant financial and administrative burden on interventional cardiologists and their hospitals [7]. As highlighted above, previous studies assessing the impact of public reporting of operator outcomes related to PCI are overwhelmingly derived from North America Editorial