New Research from NCDR Provides Insights For Improving Patient Quality

In the past month, a handful of new studies using data from one of NCDR’s 10 registries have been published. By monitoring more than 25 million patient records, these registries provide researchers with the ability to compare real-world outcomes with trial results, identify trends consistent with other studies worldwide and bring forward-looking insights to working towards improving cardiovascular care. Here we highlight two of these recent studies to help the busy physician incorporate some of these findings into their practice.

Development of Risk Model to Predict 30-Day Readmission in PCI Patients

A simple risk score model could help identify the risk of 30-day readmission in patients undergoing PCI, according to a recent study published in Catheterization and Cardiovascular Interventions.

Led by Karl E. Minges, PhD, MPH, et al., the study linked data on 388,078 PCI patients (≥65 years), who were treated at a hospital participating in ACC’s CathPCI Registry, to Medicare fee-for-service claims made between January 2007 and December 2009. The researchers randomly assigned patients to either a development cohort (n = 194,179) or a validation cohort (n = 193,899) and found similar mean 30-day unplanned readmission rates for both cohorts (11.35 percent vs. 11.36 percent respectively). Clinical and demographic characteristics were also similar across both groups. Read More >>>

Of the 19 total variables associated with the risk of 30-day readmission, 14 variables were included to identify high and low risk of 30-day readmission with a point system ranging from one to six. “Due to the challenge of quickly estimating risk […] based on 14 variables,” the authors suggest that the “risk score may be a candidate for future calculator app development.”

Upon applying the risk model to the study population, the researchers found that 15 percent of PCI patients scored ≥13 and 42 percent scored ≤6. Those who scored higher had a risk of 30-day readmission greater than 18 percent, whereas those with a lower score had a less than eight percent risk of 30-day readmission.

“The employment of this risk score in the clinical setting may translate to improved patient outcomes, proper quality assessment, and guided resource management, specifically for those patients at highest risk of readmissions,” write the authors. “Future research is needed to identify intervention strategies to reduce readmission rates, as well as identify the broader nonclinical factors that may be related to risk of 30-day readmission, such as access to and coordination of care, social support, and hospital culture and organizational behavior.”

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NCDR Study Examines Potential Implications of the PEGASUS-TIMI 54 Trial

New research looking at the use and cost implications of P2Y12 inhibitors found that they are not routinely used in the long-term care of myocardial infarction (MI) patients, and there is a higher cost per ischemic event for ticagrelor vs. clopidogrel, according to a study published April 21 in Open Heart.

Steven M. Bradley, MD, FACC, et al., aimed to assess the real-world implications of the PEGASUS-TIMI 54 trial using patients from ACC’s ACTION Registry as part of ACC’s Research to Practice initiative – which identifies impactful cardiovascular research and analyzes its implications for contemporary clinical practice using ACC’s NCDR clinical registries. Read More >>>

Researchers looked at data between Oct. 1, 2010 and April 30, 2013, and found that 41.1 percent of the 273,328 MI patients identified would have met the eligibility criteria for the trial. Results showed that among the 83,871 eligible patients with pharmacy claims data, only 27.5 percent were on a P2Y12 inhibitor one year post MI, however usage declined at two and three years post MI (11.5 percent and 6.3 percent, respectively), with the majority (79.2 percent) of these patients on clopidogrel.

Additionally, cost varied greatly by P2Y12 inhibitor type; the estimated cost per ischemic event averted using long-term ticagrelor was found to be 45 times more than the generic clopidogrel ($885,000 vs. $19,800). Therefore, if the PEGASUS strategy was adopted in clinical practice, cost would likely influence the type of therapy used, the authors explain.

The authors conclude that “applying PEGASUS trial findings to clinical practice would result in a large increase in P2Y12 inhibitor use. Given the cost implications for different P2Y12 inhibitors, additional study of long-term P2Y12 inhibitors on patient outcomes and cost of care is needed to guide optimal use of this therapy in clinical practice.”

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Keywords: ACC Publications, Cardiology Interventions, Fee-for-Service Plans, Research Personnel, Purinergic P2Y Receptor Antagonists, Ticlopidine, Medicare, Adenosine, Myocardial Infarction, Registries, National Cardiovascular Data Registries, Catheterization, Demography

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