Hospital Rankings for Heart and Heart Surgery Will Soon Include Heart Rhythm Outcomes in Their Metrics

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EP LAB DIGEST. 2025;25(5):6.

Bradley P Knight, MD, FACC, FHRS
Editor-in-Chief, EP Lab Digest

Dear Readers,

As discussed in the April 2024 editorial,¹ the outcomes of heart rhythm disorders and cardiac electrophysiology (EP) procedures have historically not been considered by hospital rankings. This is about to change.

Every year, US News and World Report (USNWR) publishes its annual hospital rankings for cardiology and cardiovascular surgery programs.² Such rankings have been challenged by some groups, including law schools and medical schools, where some have opted not to participate, but for hospitals, these ranking systems remain a source of pride and focus, and are important for their reputation and referrals. 

A glaring void in the USNWR heart program rankings are metrics for heart rhythm disorders. With the growing prevalence of atrial fibrillation (AF), the growth in ablation procedures for AF, and the ongoing high volume of cardiac implantable electrical device (CIED) implantations in this country, patients should have more information about the quality of care for heart rhythm disorders and procedures at hospitals. Currently, in the “Procedure or Condition” ratings in the USNWR scoring system, there are only 6 options applicable to heart and vascular surgery. None are related to a heart rhythm condition or procedure. These procedures or conditions include:

1. Abdominal aortic aneurysm repair

2. Heart attack

3. Aortic valve surgery

4. Heart bypass surgery

5. Heart failure

6. Transcatheter aortic valve replacement

In March 2025, USNWR announced that the Best Hospital rankings will include 2 new cohorts: “Arrhythmia” and “Pacemaker” will be added to the existing “Procedure or Condition” ratings.³ A webinar was held by USNWR on April 10, 2025, to confirm the plan. However, it remains unclear exactly what will be used to determine the rankings. In general, the Arrhythmia rating will assess each hospital’s success in caring for patients hospitalized for AF and other arrhythmias, and the Pacemaker rating will measure hospital outcomes related to treating patients who require a pacemaker. 

So far, reported outcomes for the USNWR Procedure or Condition ratings have been based on publicly available sources that include billing data and publicly reported databases such as the Society for Thoracic Surgery (STS) database. It may be that the Arrhythmia condition will only include clinical outcomes for patients admitted with an arrhythmia and not include outcomes related to ablation procedures. However, the following is a proposal of outcomes and quality metrics that could be collected using billing data for the new Arrhythmia and Pacemaker cohorts.

1. “Arrhythmia”: 

a. Length of stay, mortality, and 30-day rehospitalization for patients admitted for a heart rhythm disorder including AF

b. % of patients hospitalized with AF (and no recent major bleeding) discharged on oral anticoagulation

c. % of patients (including outpatients, who account for the vast majority of AF ablation cases) undergoing catheter ablation who experience one of the following major complications within 90 days (requiring intervention or prolonged hospitalization or resulting in death or permanent injury):

1. Pericardial effusion requiring pericardiocentesis or cardiac surgery

2. Stroke

3. Phrenic nerve paralysis

4. Atrioesophageal fistula

5. Vascular access site complication

6. Pulmonary edema or respiratory failure

2. “Pacemaker”:

a. 30-day rehospitalization for patients undergoing implantation of a CIED (pacemaker or defibrillator)

b. % of patients undergoing CIED implantation who experience one of the following major complications within 90 days (requiring intervention or prolonged hospitalization or resulting in death or permanent injury):

1. Lead dislodgment requiring lead revision

2. Pericardial effusion requiring pericardiocentesis or cardiac surgery

3. Infection requiring hospitalization or system removal

It is exciting that the outcomes of heart rhythm procedures and conditions will soon be added to the annual USNWR hospital rankings for cardiology and cardiovascular surgery programs. This is great for patients and the public, but is also great for the field. Although the attention and scrutiny that will come with this will be associated with their own challenges, this change should result in better care and more hospital and outpatient resources needed by heart rhythm teams to optimize the care of patients with heart rhythm disorders. 

Disclosures: Dr Knight has served as a paid consultant to Medtronic and was an investigator in the PULSED AF trial. In addition, he has served as a consultant, speaker, investigator, and/or has received EP fellowship grant support from Abbott, AltaThera, AtriCure, Baylis Medical, Biosense Webster, Biotronik, Boston Scientific, CVRx, Philips, and Sanofi; he has no equity or ownership in any of these companies.

References

1. Knight BP. Optimizing efficiency and outcomes in the electrophysiology lab. EP Lab Digest. 2025;25(4):6.

2. Best Hospitals for Cardiology, Heart & Vascular Surgery. US News and World Report. Accessed April 14, 2025. https://tinyurl.com/y8crlkx3

3. Seo MH, Zhou X, Harder B. Hospital ratings revamp will boost emphasis on outcomes. US News and World Report. Accessed April 14, 2025. https://tinyurl.com/24y8gwoa