Abstract 9264: Do Interventional Cardiology Training Programs Have Worse Outcomes Early in the Academic Year? An Assessment of the “July Effect” from the NCDR®
Introduction: Prior studies have demonstrated worse patient outcomes at training institutions during the early months of the academic year, a concept commonly referred to as the “July effect.” Whether the July effect exists in modern interventional cardiology practice is unknown. We hypothesized that percutaneous coronary intervention (PCI) outcomes at training institutions are worse early in the academic year.
Methods: All patients undergoing PCI for non-salvage indications from 2009-2011 within the CathPCI Registry® were eligible for inclusion. To identify training hospitals, we obtained a list of accredited interventional cardiology fellowship programs, matched them to their affiliated hospitals, and linked these training hospitals to the CathPCI Registry database through hospital identification numbers. PCI procedures were categorized as early (July 1-August 31) or non-early (September 1- June 30) based on timing within the academic year. Risk-adjusted in-hospital bleeding and mortality rates were compared for early and non-early time periods using validated risk models.
Results: A total of 216,927 procedures were performed in training hospitals during the study period. Early and non-early PCI outcomes were similar (Table 1, early vs. non-early bleeding OR 0.97, CI 0.92-1.02, mortality OR 0.94, CI 0.85-1.03). The associations between PCI timing and in-hospital bleeding and mortality were similar between hospitals with and without training programs (P for interaction 0.59, and 0.95, respectively).
Discussion: PCIs performed early in the academic year at training institutions are not associated with worse patient outcomes. Importantly for patients, within these training hospitals, this finding provides reassurance that care is not compromised when it involves trainees early in the academic year.
- © 2012 by American Heart Association, Inc.