This post was authored by William J. Oetgen, MD, MBA, FACC, executive vice president of Science, Education, & Quality of the ACC.

I recently had the opportunity, along with other members of the ACC staff, to serve on the research team for a project that analyzed data from the PINNACLE Registry India database. The database now includes well over 100,000 patient records collected from Indian hospital outpatient clinics. Using this database, Yashashwi  Pokharel, MD, MSCR, and a team of his colleagues recently submitted an abstract entitled “Guideline Recommended Medication Use Among Systolic Heart Failure (HF) Patients in India: Insights from the American College of Cardiology Practice Innovation and Clinical Excellence (PINNACLE) India Registry,” to the 66th Annual Conference of the Cardiological Society of India. The abstract was selected for a prestigious oral presentation at the conference this past December, which was delivered by Prafulla Kerkar, MD, FACC, the Mumbai-based chair of the PINNACLE India research group. Not only does this study inform us on guideline-recommended medication use among patients in India, but it also marks the first time data from ACC’s outpatient registry in India have been presented at a conference outside of the U.S.

PINNACLE India is the first cardiovascular data collection and reporting program implemented in India and the efforts put forth by providers are helping to build an important cross-border dataset. The PINNACLE Registry, like the other NCDR Registries, serves as a quality improvement tool for providers and practices, but it also provides the large-scale data needed to answer questions about patient risk factors and outcomes; procedure and treatment trends; guidelines adherence; and device, facility and provider characteristics. PINNACLE India will help Indian cardiologists to improve cardiovascular care within their country and will also allow them to compare outcomes and trends to those of the U.S.

For the study, the research team examined medication use (ACE inhibitors/angiotensin receptor blockers, beta blockers or both) in outpatients with systolic HF in India. The study examined data from patients with ejection fraction (EF) <40 percent from five outpatient centers captured between January 2012 to June 2014.

In 52,880 patients with reported EF, 30 percent had EF <40 percent. Among patients with systolic HF enrolled in the PINNACLE India Registry, about two-thirds did not have documentation of receipt of guideline recommended medications. This study has limitations and certainly is not meant to imply a poor standard of care among PINNACLE India participating facilities. Rather, these results may indicate an opportunity to improve quality of care and documentation of medication therapy concordant with treatment guidelines for patients with EF <40 percent in India.

While data on documented medication use among HF patients in PINNACLE India are still limited, taking a closer examination at the trends in medication use in the Indian population would impel investigation into the socioeconomic, cultural and genetic factors that influence HF treatment in this country.

In addition to the research presented in India, there was an array of PINNACLE Registry research released in the U.S. in 2014. Two recent studies by Thomas M. Maddox, MD, MSc, FACC, and William B. Borden, MD, FACC, provide unique insight into the potential impacts of the new ACC/American Heart Association (AHA) cholesterol guidelines, as well as new recommendations for the management of hypertension. Both studies, presented as part of AHA 2014 and simultaneously published in the Journal of the American College of Cardiology, provide examples of how data from a large, contemporary clinical registry like PINNACLE can provide important, timely perspectives on current cardiovascular care in the U.S.

Additional notable PINNACLE Registry research published in 2014 included:

• Variation in CAD Secondary Prevention Prescription Among Outpatient Cardiology Practices: Insights From the NCDR
• Frequency and Practice-Level Variation in Inappropriate and Nonrecommended Prasugrel Prescribing
• Contemporary Use of Dual Antiplatelet Therapy for Preventing Cardiovascular Events
• Variations in Coronary Artery Disease Secondary Prevention Prescriptions Among Outpatient Cardiology Practices: Insights From the NCDR

To learn more about research conducted using NCDR data, visit NCDR.com.

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