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WASHINGTON (Apr 03, 2019) -
Data from the American College of Cardiology's NCDR was the source of several studies published and presented in recent months, including studies examining different valve therapies and their outcomes on overall health and rehospitalization and the role of volume on outcomes. Other studies looked at the insurance rates and types of insurances used by heart attack and coronary artery disease patients, along with their outcomes.
NCDR Study Finds TMVR Improves Health in Patients After One Year
Most patients who are still alive one year after undergoing transcatheter mitral valve repair (TMVR) have improvements in symptoms, functional status and quality of life, according to a study published Nov. 21 in JAMA Cardiology. Suzanne V. Arnold, MD, MHA, et al., measured changes in health status of TMVR patients by using the STS/ACC TVT Registry to analyze patients' Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS) scores 30 days and one year after the procedure. A total of 7,504 patients underwent TMVR at 240 sites during the study period. KCCQ-OS data were available for 4,226 patients at 30 days. Among these patients, the average KCCQ-OS score increased from 41.9 at baseline to 66.7 at 30 days. Average KCCQ-OS scores also increased for the 1,124 patients for whom one-year data were available – from 42.3 at baseline to 71.4 at one year. Read more.
Rate of Uninsured AMI Patients Decreased After Medicaid Expansion, NCDR Study Finds
States that expanded Medicaid eligibility as part of the Affordable Care Act experienced a significant decrease in the number of uninsured patients hospitalized for acute myocardial infarction (AMI), according to a study published Jan. 16 in JAMA Cardiology. Rishi K. Wadhera, MD, MPP, et al., used data from ACC's Chest Pain – MI Registry to assess whether uninsurance rates, quality of care and outcomes among hospitalized AMI patients changed in states that expanded Medicaid vs. those that did not. The researchers looked at trends in insurance status before and after Medicaid expansion in an initial cohort of 325,343 AMI patients younger than age 65. According to the results, the rate of uninsured AMI hospitalizations decreased from 18 percent before expansion to 8.4 percent post-expansion. States that did not expand Medicaid experienced a smaller decrease – 25.6 percent pre-expansion to 21.1 percent post-expansion. The number of patients with Medicaid coverage rose to 14.4 percent from 7.5 percent in expansion states vs. an increase to 6.6 percent from 6.2 percent in nonexpansion states. Read more.
Is There a Volume-Outcome Relationship in TAVR?
A volume-outcomes relationship may not exist for current generation balloon-expandable valves after the initial learning curve of about 200 cases, and therefore all TAVR centers should be able to "achieve consistently excellent outcomes," according to a study published Jan. 28 in the Journal of the American College of Cardiology. Mark J. Russo, MD, MS, et al., used data from the STS/ACC TVT Registry to determine whether a volume-outcomes relationship persisted for balloon-expandable TAVR after the initial learning curve and whether the learning curve and volume-outcomes relationship differed for different device generations. The researchers analyzed data from 61,949 balloon-expandable valve implants. Results showed that for all valve types, sites experienced an initial learning curve that ended after about 200 cases. After that point, there was no relationship between volumes and outcomes. Read more.
Clinical Trials of ULM PCI May Not Reflect Contemporary Practice
Randomized clinical trials demonstrating safety and efficacy of unprotected left main (ULM) PCI may not reflect its use in clinical practice, according to a study published Jan. 2 in JAMA Cardiology. The study is part of ACC's Research to Practice (R2P) initiative, which identifies impactful cardiovascular research and analyzes its implications for contemporary clinical practice using ACC's NCDR clinical registries. Using ACC's CathPCI Registry, Javier A. Valle, MD, MSCS, FACC, et al., analyzed data from 33,128 patients undergoing ULM PCI and 3,309,034 undergoing all other PCI to define current ULM PCI practice and compare outcomes to those reported in the EXCEL and NOBLE trials. Read more.
NCDR Study Looks at Medicare Advantage vs. Medicare FFS in Patients with CAD
Medicare Advantage patients with coronary artery disease (CAD) may be more likely to receive secondary prevention treatments than Medicare Fee-for-Service (FFS) beneficiaries with CAD, but these treatments may not improve outcomes, according to a study published Feb. 20 in JAMA Cardiology. Jose F. Figueroa, MD, MPH, et al., used data from ACC's PINNACLE Registry to assess differences in delivery of evidence-based treatments and outcomes in 35,563 CAD patients enrolled in Medicare Advantage plans vs. 172,732 CAD patients in Medicare FFS plans. The primary study outcomes were prescription patterns among eligible patients and outcomes, including blood pressure and low-density lipoprotein cholesterol. Results showed that Medicare Advantage beneficiaries received secondary prevention treatments more often than those in FFS plans – including beta blockers (80.6 percent vs. 78.8 percent); angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (70.7 percent vs. 65.1 percent); and statins (68.4 percent vs. 64.5 percent). Medicare Advantage patients were also more likely than FFS patients to receive all three medications when eligible (48.9 percent vs. 40.4 percent). Read more.
NCDR Research Highlighted at ACC.19
Several abstracts based on NCDR data were presented during ACC.19 in New Orleans, March 16 – 18. Expanding on previous years, these abstracts highlight the role of NCDR registries in practice-changing clinical research. Read more.
TAVR Patients Less Likely to Have HF Hospitalization Post-Procedure, NCDR Study Finds
TAVR patients with severe aortic stenosis (AS) may have fewer heart failure (HF) hospitalizations post-procedure but have higher rates of all-cause, noncardiovascular and bleeding hospitalizations, according to a study published March 11 in the Journal of the American College of Cardiology. Sreekanth Vemulapalli, MD, et al., used the STS/ACC TVT Registry to look at the effect of TAVR on hospitalizations in patients with severe AS. The researchers linked registry data to Medicare claims data for 15,324 patients who underwent TAVR at 328 sites and examined rates of all-cause, cardiovascular and noncardiovascular hospitalizations and hospital days. In addition, the researchers looked at inpatient costs in the year before TAVR and the year after the procedure. Results show that HF was the most common reason for hospitalization, occurring in 15.9 percent of patients in the year before TAVR and 14.2 percent in the year post-TAVR. Rates for all-cause, noncardiovascular and bleeding hospitalizations and hospital days increased in the year after the procedure. Read more.
NCDR Study Finds AFib Associated with Higher One-Year Mortality, HF in TMVR Patients
Patients undergoing transcatheter mitral valve repair (TMVR) who have atrial fibrillation (AFib) have higher rates of mortality and heart failure (HF) after one year than those without AFib, according to a study published March 18 in JACC: Cardiovascular Interventions. Using data from the STS/ACC TVT Registry, Sameer Arora, MD, et al., compared one-year outcomes for patients with and without AFib who had TMVR with MitraClip between 2013 and 2016. The primary outcome was the composite rate of death or HF hospitalizations one year after the procedure. Secondary outcomes were one-year rates of stroke and bleeding events. The results show that among 5,613 patients undergoing TMVR, 63 percent had AFib at baseline. After the procedure, inpatient mortality was similar for patients with and without AFib (2.7 percent vs. 2.0 percent). Post-TMVR length of stay was 7.7 days for AFib patients vs. 7 days for those without. Among patients who did not have AFib at baseline (2,058), 78 developed AFib after the procedure. Read more.
About 1 in 6 HFrEF Patients Develop Worsening HF Within 18 Months, NCDR Study Shows
About one in six patients with heart failure with reduced ejection fraction (HFrEF) develop worsening HF within 18 months of initial HF diagnosis, according to a study published Feb. 25 in the Journal of the American College of Cardiology. Javad Butler, MD, MPH, MBA, FACC, et al., linked data from medical records of 11,064 patients with HFrEF in ACC's PINNACLE Registry to pharmacy, private practice and hospital claims databases to assess incidence, clinical characteristics, treatment and outcomes. The results show that of all 11,064 HFrEF patients, 16.7 percent developed worsening HF about 18 months after the initial HF diagnosis. African-Americans and patients age 80 and older were more likely to develop worsening HF. In addition, 100 percent of patients with worsening HF had at least one cardiac or noncardiac comorbidity, such as hypertension, coronary artery disease or atrial fibrillation. 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.