Award-winning posters at ACC Quality Summit 2023, held Oct. 11-13 in Orlando, FL, investigated the use of a double fluoroscopy method and unique access and closure protocol in patients undergoing TAVR; uptake in guideline-directed medical therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF); and the impact of the iodinated contrast shortage on incidence of contrast-associated acute kidney injury (AKI). The ACC accepted more than 100 ePoster abstracts to showcase at the exhibition during this year’s Summit.

Presenting author Connor Emmert, RN, from The Valley Hospital in Ridgewood, NJ, received the first-place for his study aiming to reduce vascular complications among the facility’s TAVR patients. The quality improvement team implemented several interventions including a consistent procedure approach, double fluoroscopy method to gain access and standardized post procedure image review at the time of closure. The study included 187 patients undergoing TAVR and defined vascular complications as any aortic dissection, aortic rupture, annulus rupture, left ventricle perforation, new apical aneurysm/pseudo-aneurysm, any access site or access related injury, or distal embolization within 30 days. According to NCDR data, the facility’s vascular complication rate was 4.3% in Q2 2022 and 7% in Q3 2022. Following implementation, the complication rate dropped to 2.6% in Q4 2022 and 0% in Q1 2023. Emmert also noted a positive impact on patient satisfaction through earlier discharge, presenting the following rates of next-day discharge: 89% in Q2 2022, 68% in Q3 2022, 75% in Q4 2022 and 87% in Q1 2023.

Taking second place, Roshan Kaphle, DO, from Ascension St. Vincent Hospital in Indianapolis, IN, employed strategies to improve utilization of GDMT for HFrEF in the inpatient setting. The single-center, retrospective study looked at initiation and titration of all four classes of GDMT for patients with HFrEF: renin-angiotensin inhibitors (ACE inhibitors/ARBs/ARNI), beta-blockers, mineralocorticoid receptors antagonists (MRAs), and SGLT2 inhibitors. Researchers analyzed a pre-intervention group of 228 patients from January 2022 to June 2022 to establish baseline data and identify interventions for quality improvement. They then provided education to residents, hospitalists, cardiology advanced practice providers and pharmacists, established a monthly review of GDMT utilization data by a performance improvement consultant, and sent emails to each clinician regarding patients who were not discharged on all four pillars of GDMT. Data from a post-intervention group of 227 patients from December 2022 to May 2023 revealed a significant increase in patients discharged on ARNI (23.7% pre-intervention vs. 36.6% post-intervention, p=0.001) as well as SGLT2 inhibitors (19.7% vs. 33.5%, p≤0.001), but no significant increase in ACE inhibitor/ARB or beta-blocker prescription at discharge was observed. Additional benefits from the project included a marked improvement in documentation for why GDMT was not utilized.

Lisa Foster, MOL, RTR(CV), from Baylor Scott & White Heart Hospital in Plano, TX, was awarded with third place for her retrospective, single-center study investigating whether the pandemic-associated iodinated contrast shortage had an impact on the incidence of contrast-associated AKI. Including 265 patients undergoing PCI, researchers found the incidence of contrast-associated AKI significantly decreased from a pre-contrast shortage rate of 11.5% to 4.6% during the shortage (p=0.038). Study authors analyzed several secondary endpoints including average contrast volume per PCI, which dropped significantly during the shortage (122.8 mL ±62 vs. 88.2 mL ±45.6, p<0.001), coronary imaging use, which increased during the shortage (34.2% vs. 50%, p=0.009), and all-cause mortality at discharge, which was comparable between study periods (2.79% vs. 3.28%, p=0.895). From these findings, Foster proposes the use of ultra-low contrast PCI techniques like dynamic road mapping, intravascular ultrasound coronary imaging and coronary physiology tools may reduce risk of contrast-associated AKI, producing better PCI outcomes and potentially better clinical outcomes.

The People’s Choice Award, announced the final day of the Summit, was won by presenting author Terri Ohrn, BART(R), ARRT, from WVU Camden Clark Medical Center in Parkersburg, WV, for a poster looking at optimizing the inpatient chest pain alert process to improve the facility’s electrocardiogram (ECG)-to-read times. The quality team implemented the use of secure EPIC chat communications, an electronic medical record tool, to streamline their chest pain alert process allowing nurses to stay with their patients during chest pain episodes and physicians to respond promptly with ECG results. The facility was able to decrease the average alert-to-read time from 21 minutes to 7 minutes, meeting the ACC’s recommendation of 10 minutes or less.

In addition, three posters submitted to the Quality Summit received honorable mentions:

• Multidisciplinary Team Cultivation of a Quality Same Day Discharge Program For Cardiac Cath Lab Procedures
  Kathryn Jaramillo, MS, RN, CNS-BC, AACC
  El Camino Health
• Reducing the Risks: A Quality Improvement Project For the Prevention of Atrial Fibrillation in Cardiac Surgery Patients
  Shannon Crotwell, RN, BSN, CCRN
  Atrium Health
• Utilizing Leadless Arrythmia Monitoring Devices After Transcatheter Aortic Valve Implantation to Prevent Operative Mortality
  Courtney Shaw, BSN, RN, RN-BC
  Houston Methodist The Woodlands Hospital

For more coverage of ACC Quality Summit 2023, check out the meeting’s digital newspaper.