Risk Adjustment Tools in Congenital Heart Disease
A Consumer’s View
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Article, see p 2009
The use of risk adjustment methods to assess the safety of procedures for congenital heart disease began 15 years ago.1,2 It is a good thing. Like many cardiologists and surgeons, I do not develop the tools, and I have never learned any of the arcana of methods and statistics used to develop those tools. However, I have relied on and continue to use them as an integral part of understanding the performance of an individual, program, or field. The current article by Jayaram et al3 in Circulation improves our understanding of the risks of catheterization for congenital heart disease, extending prior work4 to the many more patients and centers in the IMPACT Registry (Improving Pediatric and Adult Congenital Treatments). This article is a welcome addition to the field.
Given this work, a consumer should perhaps be thinking about 3 questions. What are the probable weaknesses of all such tools? What are the weaknesses specific to this one? How …