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Globe: State Examines 2009 Uptick In Heart Deaths At BIDMC

Image of a cardiac catheterization from a Berlin hospital

State public health authorities are looking into a 2009 uptick in the death rate from emergency cardiac catheterization procedures at Beth Israel Deaconess Medical Center, the Globe’s White Coat Notes reports here.

An analysis of mortality data for the fiscal year ending Sept. 30, 2009, showed that 13 of 93 patients who underwent the procedure died. Beth Israel Deaconess’s mortality rate — after adjusting for how ill the patients were — was 5.82 percent, compared with 5.12 percent for hospitals statewide, according to state public health officials.

The hospital’s mortality rate for the 1,039 non-emergency cardiac catheterization patients in 2009 was average.

Doctors at the hospital said their internal investigation, as well as a review by a top cardiologist from Brigham and Women’s Hospital, found that no patients died as a result of complications of emergency heart catheterizations, or from post-surgical care. And since 2009, hospital executives said, the death rate has fallen among patients who undergo the emergency procedure to remove blockages from their coronary arteries.

Beth Israel says the state didn’t account fully enough for how sick the patients were; the state questions whether some patients might have been too sick for the procedure, and says that issue will be examined.

The hospital sent around this internal email:

To: BIDMC Community

From: Donald Cutlip, MD
Section Chief,
Interventional Cardiology

Kenneth Sands, MD
Senior Vice President,
Silverman Institute for Health Care Quality and Safety

Subject: State Releases Data on Cardiac Treatment Outcomes

The Massachusetts Department of Public Health (DPH) report for statewide post-procedure mortality data for coronary artery bypass surgery and coronary angioplasty (also called percutaneous coronary intervention, or PCI) for FY2009 was released today. We are writing to let you know that BIDMC’s mortality rate among one small group of PCI patients will be identified as being higher than expected.

We take this matter very seriously and have looked at all of the data carefully. After a detailed examination of each of the cases in question, we have found no evidence that any patient died as a result of a complication during the angioplasty procedure itself or as a result of post-procedure care. Rather, we believe that the deaths were due to serious underlying medical conditions. However, to be certain that nothing was overlooked in our internal assessment, we enlisted Dr. David Williams from Brigham and Women’s Hospital to conduct an independent evaluation of these cases, and his conclusions are supportive of our internal review. We will follow this up with a second independent review of our program by the American Medical Foundation.

The DPH findings related only to a small group of patients with the most serious forms of heart disease, including certain types of heart attack and many patients with cardiac arrest or shock (a condition in which the heart is severely weakened and is unable to maintain blood pressure). During the year being reported (October 1, 2008 through September 30, 2009) this group represented less than 10 percent of all patients undergoing PCI at BIDMC. The finding of higher mortality is based on 13 deaths occurring in this population.

We are pleased that this DPH report found no concerns about post-procedure mortality among a much larger group of less ill patients receiving PCI at BIDMC (more than 90 percent of patients undergoing angioplasty.) Furthermore, a report from the Federal Center for Medicare & Medicaid Services (CMS) showed that for all Medicare patients who received care for heart attacks at BIDMC between July 2006 and June 2009, the risk of mortality was lower than the national average; in fact, BIDMC was ranked in the top 3 percent of hospitals.

BIDMC’s Interventional Cardiology Service is among the best in the world and is consistently one of the two highest-volume centers in Boston. Our Division fully supports public reporting and transparency regarding patient outcomes, and members of our interventional cardiology staff serve prominent local and national roles in this area. We will continue our efforts to make certain that outcomes reports are informative for improving the quality of care for all patients, including those who are critically ill and may benefit from potentially life-saving treatments, which will never be completely risk free.