THE BLEEDING RISK TREATMENT PARADOX AT THE PHYSICIAN 1 AND HOSPITAL LEVEL: IMPLICATIONS FOR REDUCING BLEEDING IN PATIENTS UNDERGOING PCI.
American heart journal
oregon; portland; cards; cards publication
BACKGROUND: Bleeding is a common and costly complication of percutaneous coronary intervention (PCI). Bleeding avoidance strategies (BAS) are used paradoxically less in patients at high-risk of bleeding: "bleeding risk-treatment paradox" (RTP). We determined whether hospitals and physicians, who do not align BAS to PCI patients' bleeding risk (i.e., exhibit a RTP) have higher bleeding rates.
METHODS: We examined 28,005 PCIs from the NCDR CathPCI Registry for 7 hospitals comprising BJC HealthCare. BAS included transradial intervention (TRI), bivalirudin (BIV), and vascular closure devices (VCDs). Patients' predicted bleeding risk was based on NCDR CathPCI bleeding model and categorized as low (
RESULTS: Amongst 28,005 patients undergoing PCI by 103 physicians at seven hospitals, RTP was observed in 12,035 (43%) patients. RTP was independently associated with a higher likelihood of bleeding even after adjusting for predicted bleeding risk, mortality risk and potential sources of variation (OR 1.66, 95%CI 1.44-1.92, P
CONCLUSIONS: Bleeding RTP is a strong, independent predictor of bleeding. It exists at the level of physicians and hospitals: those with a higher rate of RTP had worse bleeding rates. These findings not only underscore the importance of recognizing bleeding risk upfront and using BAS in a risk-aligned manner, but also inform and motivate national efforts to reduce PCI-related bleeding.
Amin, Amit P; Frogge, Nathan; Kulkarni, Hemant; Ridolfi, Gene; Ewald, Gregory; Miller, Rachel; Hall, Bruce; Rogers, Susan; Gluckman, Tyler J; Curtis, Jeptha; Masoudi, Frederick A; and Rao, Sunil V, "THE BLEEDING RISK TREATMENT PARADOX AT THE PHYSICIAN 1 AND HOSPITAL LEVEL: IMPLICATIONS FOR REDUCING BLEEDING IN PATIENTS UNDERGOING PCI." (2021). Articles, Abstracts, and Reports. 5286.