Key result
CMS and NCDR criteria show only modest agreement on primary PCI delays, excluding ~28% vs ~12%.
Why the study?
Is there discordance between CMS and NCDR registries in defining unavoidable delays for primary PCI?
Observational (n=456)
Yes
Is there discordance between CMS and NCDR registries in defining unavoidable delays for primary PCI?
There is significant discordance between CMS and NCDR registries in defining unavoidable delays for primary PCI, highlighting challenges in standardized quality assessment.
Answers are grounded in this paper and cite their sources.
Discordance in defining unavoidable delays may bias primary PCI quality metrics; leaves open need for harmonized registry criteria.
BACKGROUND: The Centers for Medicaid and Medicare Services (CMS) and the National Cardiovascular Data Registry (NCDR) track primary percutaneous coronary intervention (PCI) performance in the form of door-to-balloon time. For quality assessment, exceptions are made for patients with "unavoidable delays" in both registries, yet it remains unclear how consistently such patients are identified. METHODS AND RESULTS: All primary PCI patients at 3 Massachusetts hospitals (Brigham and Women's, Massachusetts General, and North Shore Medical Center) from 2009 to 2011 were evaluated for CMS inclusion/exclusion and NCDR nonsystems delay (NSD) status. We subsequently analyzed patient characteristics and outcomes based on these strata. Among 456 total patients, 128 (28%) were excluded from CMS reporting, whereas 56 (12%) were listed in the NCDR registry as having an NSD. Forty of 56 (71%) patients with NSD were also excluded from CMS reporting, whereas 312 of 400 (78%) patients reported without NSD were included in CMS reports. Between-registry agreement on patients with unavoidable delays was modest (κ=0.32). Among CMS-included patients without NSD, 94% received PCI within 90 minutes compared with 29% of CMS-excluded patients with NSD (P<0.001). Likewise, CMS-included patients without NSD had a 4-fold better 1-year mortality rate compared with CMS-excluded patients with NSD (P<0.001). CONCLUSIONS: More than twice as many primary PCI patients are excluded from CMS quality analyses compared with NCDR. With the use of currently available cardiovascular quality registries, it is unclear how many patients truly require unavoidable delays during primary PCI. Patients with NSD had the worst outcomes regardless of CMS status.
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McCabe et al. (2014) conducted an observational in ST-segment elevation myocardial infarction (STEMI) requiring primary PCI (n=456). NCDR non-systems delay (NSD) designation vs CMS exclusion status vs. CMS-included without NSD was evaluated on Between-registry agreement on patients with unavoidable delays before primary PCI (κ=0.32). There was only modest agreement (κ=0.32) between CMS and NCDR registries regarding unavoidable delays before primary PCI, with 28% of patients excluded by CMS compared to 12% designated with delays in NCDR.
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