Registry Data Shows Early Patterns for New Atrial Fibrillation Treatments

Contact: Stephanie Abraham,, 202-375-6296

WASHINGTON (August 14, 2012) — The American College of Cardiology (ACC) today released first findings from its expanded outpatient registry, the PINNACLE Registry, focusing on atrial fibrillation and including the next generation of anticoagulants.

The new platform, PINNACLE-AF, operates within the existing PINNACLE Registry.  The PINNACLE Registry is the largest cardiovascular outpatient database in the U.S., and is part of the ACC’s National Cardiovascular Data Registry (NCDR). NCDR is the most comprehensive, outcomes-based cardiovascular patient data registry for quality improvement in the United States.

“As new treatments for atrial fibrillation come online, assessing shifts in care patterns—and the impact of these shifts on patients—is a top clinical and research priority.  We are interested to see if these new medications change the way doctors think about stroke prevention and help us close a long-standing quality gap in anticoagulation,” said William J. Oetgen, MD, MBA, FACC, FACP, Senior Vice President of Science and Quality at the ACC.

It is documented in the PINNACLE Registry as well as in the peer-reviewed atrial fibrillation literature that nearly half of all atrial fibrillation patients at moderate to high risk of stroke are not anti-coagulated according to current scientific guidelines. In a 2011 study, Paul S. Chan and colleagues concluded anticoagulation rates of 55.1 percent in a population of 10,000 patients in the PINNACLE Registry showed an “almost random pattern of treatment” when all clinical variables were considered.

More recent unpublished analysis from PINNACLE-AF on just over 121,000 unique atrial fibrillation patients from calendar year 2011 shows an overall anticoagulation rate just shy of 50 percent, a finding consistent with Chan’s earlier article. Unique to this analysis, however, is the inclusion of the novel oral anticoagulants dabigatran and rivaroxaban, which entered the market in late 2010 and late 2011 respectively.  Of all anticoagulated AF patients, 12.6 percent were prescribed novel oral anticoagulants while 87.4 percent remained on warfarin. 

“These data indicate to us that PINNACLE-AF is already yielding powerful clinical insights,” Oetgen said. “While this is at an admittedly early stage, we are exploring the hypothesis that novel oral anticoagulants appear to most often be used as an alternative to warfarin in patients already treated or likely to be treated, rather than as an option for patients previously not anti-coagulated for stroke prevention.”  The PINNACLE Registry Research and Publications sub-committee is currently analyzing these data in preparation for a manuscript that will be submitted for peer review.

PINNACLE currently has 4.7 million patient records representing valid patient encounters from hundreds of outpatient practices nationwide. Of those patients, over 250,000 have atrial fibrillation. Participation in the Registry is free to all cardiology practices. 

To provide deeper data repository for future research and innovation, PINNACLE-AF also includes data elements related to kidney function and bleeding risk and events.  Distribution of detailed PINNACLE-AF reports to participating providers will begin in the third quarter of 2012.   

Atrial fibrillation is a cardiac rhythm disorder in which the upper chambers of the heart, the atria, beat irregularly and out of sync with the two lower chambers. Symptoms include an irregular or rapid heart rate, shortness of breath, and weakness.  While atrial fibrillation itself is not commonly fatal, it often is associated with increased risks of death and stroke. 

Bristol-Myers Squibb and Pfizer, Inc. provide financial support for PINNACLE-AF. For more information about the PINNACLE Registry and PINNACLE-AF, visit




A bout the American College of Cardiology
The mission of the American College of Cardiology is to transform cardiovascular care and improve heart health. The College is a 40,000-member nonprofit medical society comprised of physicians, surgeons, nurses, physician assistants, pharmacists and practice managers, and bestows credentials upon cardiovascular specialists who meet its stringent qualifications. The College is a leader in the formulation of health policy, standards and guidelines, and is a staunch supporter of cardiovascular research. The ACC provides professional education and operates national registries for the measurement and improvement of quality care. More information about the association is available online at

About the NCDR
The NCDR is the preeminent cardiovascular data repository in the United States today. Through the analysis and benchmarking of patient risk factors, procedures, devices and clinical outcomes, the NCDR’s growing suite of registries provides evidence-based quality improvement solutions for cardiologists and other medical professionals who are committed to measurement, improvement and excellence in cardiovascular care. More information about the NCDR is available online at

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