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WASHINGTON (Jan 07, 2019) -
Data from the American College of Cardiology's NCDR was the source of several studies published and presented in recent months, including whether heart failure hospitalization increases ICD complications, machine learning to improve acute kidney injury risk prediction in PCI patients and the impact of where a patient lives and their care following heart attack.
NCDR Study Shows Bleeding Risk May Be Higher in TAVR Patients Prescribed DAPT
TAVR patients who are discharged with dual antiplatelet therapy (DAPT) may have a significantly higher risk of major bleeding events vs. patients who are discharged with antiplatelet monotherapy, according to a study published in the American Heart Journal. Matthew W. Sherwood, MD, MHS, FACC, et al., used data from the ACC/STS TVT Registry to analyze 16,694 patients who underwent TAVR at 444 hospitals between 2011 and 2016. According to the results, 81.1 percent of patients were discharged on DAPT (aspirin and a P2Y12 inhibitor). The remaining 18.9 percent of patients were discharged with either aspirin or a P2Y12 inhibitor. Among all study participants, 11 percent had died within one year of undergoing TAVR. After adjusting for clinical characteristics, rates of death, stroke and myocardial infarction at one year were similar between patients on DAPT and those on monotherapy. However, patients on DAPT had a significantly higher risk of major bleeding events. Read more.
NCDR Study Finds Heart Failure Hospitalization May Increase ICD Complication Rates
Patients undergoing initial ICD placement for primary prevention who are currently hospitalized or have been recently hospitalized for heart failure (HF) may be more likely to experience periprocedural complications or death, according to a study published in Circulation. Andrew P. Ambrosy, MD, et al., used data from ACC's ICD Registry and Medicare claims to assess associations between the timing of ICD placement and outcomes during hospitalization and at 30 days and 90 days postimplantation. The study cohort consisted of 81,180 patients with a diagnosis of HF with reduced ejection fraction ≤35 percent who received an ICD for primary prevention. Results showed that about 20 percent of the study population were currently hospitalized or had been hospitalized within three months. In addition, patients hospitalized at the time of ICD placement or within three months had higher rates of all-cause mortality, all-cause admissions and cardiovascular admissions at both 30 days and 90 days after implantation. Read more.
NCDR Study Finds Machine Learning Could Improve AKI Risk Prediction After PCI
The use of machine learning and data-driven approaches could be more accurate at predicting acute kidney injury (AKI) in PCI patients than the current risk prediction model used in ACC's CathPCI Registry, according to a study published in PLoS Medicine. Chenxi Huang, PhD, et al., used the original cohort – 947,091 patients – and variables that guided development of the CathPCI Registry's current AKI risk prediction model to create a series of new models with machine learning techniques and then compared performance of both models. In the original patient cohort, there were 69,826 (7.4 percent) AKI events. In comparisons to the original model, the new model derived from machine learning reclassified 42,167 patients whose AKI risk was underestimated with the original model and 61,388 whose risk was overestimated. The researchers also validated the new models using a new cohort of 970,869 patients. Results showed that the machine learning model was more accurate than the traditional one in several variables. Read more.
Does a Patient's Neighborhood Affect Myocardial Infarction Care?
Patients from disadvantaged neighborhoods may receive similar care for myocardial infarction (MI) as those from higher-income neighborhoods but may be at higher risk of adverse in-hospital outcomes, according to a study published in Circulation: Cardiovascular Quality and Outcomes. Jacob A. Udell, MD, MPH, et al., used data from ACC's Chest Pain – MI Registry, formerly the ACTION Registry, and the U.S. Census Bureau to look at 390,692 MI patients who received treatment at 586 hospitals between 2008 and 2013. Results showed that neighborhood socioeconomic status, insurance status and hospital characteristics were not associated with lower rates of guideline-recommended care. However, patients from disadvantaged neighborhoods waited longer for angiography after arriving at the hospital and were less likely to receive referrals for cardiac rehabilitation at discharge. In addition, patients from lower-income neighborhoods were at a higher risk of adverse in-hospital outcomes, including mortality and major bleeding, regardless of clinical risk factors, insurance status and hospital characteristics. Read more.
Can a Predictive Model Identify AMI Patients at Risk of 90-Day Readmissions?
A clinical model that uses variables known at discharge may be effective in predicting 90-day readmission risk for patients with acute myocardial infarction (AMI), according to a study published in Circulation: Cardiovascular Quality and Outcomes. Using data from ACC's Chest Pain – MI Registry, Vinay Kini, MD, MSHP, et al., identified 86,849 Medicare beneficiaries who were discharged with a primary diagnosis of AMI and developed a model to assess a patient's risk of readmission within 90 days. The researchers randomly assigned 70 percent of the patients to the predictive model. According to the results, 23,912 patients (27.5 percent) were readmitted within 90 days. More than half of all readmissions (55 percent) occurred within 30 days, and 81 percent occurred within 60 days. Predictors of readmission included older age and a history of diabetes or heart failure. Read more.
NCDR Study Finds Significant Variations in Lipid Therapy
Evidence-based use of lipid-lowering therapy is low among patients whose low-density lipoprotein cholesterol (LDL-C) is greater than or equal to 190 mg/dL, with significant practice-level variations in care, according to a study published in Circulation: Cardiovascular Quality and Outcomes. Salim S. Virani, MD, PhD, FACC, et al., identified 49,447 patients in ACC’s PINNACLE Registry with LDL-C ≥ 190 mg/dL taking a statin, high-intensity statin, lipid-lowering therapy associated with at least a 50 percent reduction in LDL-C, ezetimibe or PCSK9 inhibitor. Results showed that among all patients, about 4 in 10 were not receiving any statin therapy and fewer than one-third were treated with high-intensity statins. There was also a 20 percent variation in the use of statins and 131 percent variation in the use of high-intensity statins for two similar patients treated at two random practices. Read more.
NCDR data and news was also previously highlighted. Read more:
The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its more than 52,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care, and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.