PINNACLE Registry Studies Examine Use of Guideline-Recommended Therapies; Clinician Experience, Guideline Adherence

Recent research using data from ACC and Veradigm's PINNACLE Registry highlighted the association between guideline-recommended care and medication use for apparent treatment resistant hypertension; statin therapy, stratified by patient income; and anticoagulation in patients with atrial fibrillation (AFib) and heart failure. Another study compared clinician experience and adherence to guideline-recommended care.

Patients With aTRH May Not Be Receiving Most Recent Guideline-Based Care

The use of guideline-recommended therapy in patients with apparent treatment resistant hypertension (aTRH) may be low, according to a study published in the American Journal of 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.

Anna M. Maw, MD, MS, et al., used the PINNACLE Registry to look at the prevalence of aTRH and recommended therapies to determine the implications of a 2018 American Heart Association (AHA) scientific statement on resistant hypertension and therapies.

The researchers identified 84,624 patients receiving hypertension treatment and determined the proportion with aTRH who were taking blood pressure medication from three classes or who were taking four or more blood pressure medications.

Of the 84,624 patients, 11,147 (13.1%) met criteria for aTRH. The study found significant differences between past medication classes commonly used in those with aTRH and the medication classes recommended in most recent guidelines.

According to the researchers, the results highlight potential opportunities to improve the management of aTRH by targeting the use of guideline-recommended therapies.

The R2P initiative was launched in 2015. Analyses under the R2P initiative are intended to help facilitate conversations between practice and research, and identify unanswered questions in current clinical research and future investigation topics to consider.

Higher-Income Patients More Likely to Receive Recommended Statin Treatment

Higher-income patients may be more likely than those with lower incomes to receive lipid-lowering statin therapy, according to a study published in Cardiovascular Revascularization Medicine.

Varsha K. Tanguturi, MD, et al., used data from the PINNACLE Registry to identify 1,655,723 patients who were candidates for lipid-lowering therapy and evaluate the association between income level and appropriate treatment. Patients were divided into quintiles based on income.

The researchers used Adult Treatment Panel (ATP) III guidelines to determine appropriateness of statin therapy for patient visits that occurred between 2008 and November 2013, when new ACC/AHA guidelines were released. From November 2013 through 2016, the researchers used the ACC/AHA guideline to determine appropriate treatment.

Patients with higher estimated income had a small but significant increased likelihood of appropriate statin therapy, the researchers conclude. They note that further research should look at the barriers of using evidence-based treatments in lower-income populations.

AFib Patients With HFpEF Less Likely to Receive Anticoagulation vs. Those With HFrEF

Patients with nonvalvular atrial fibrillation (NVAF) and heart failure with preserved ejection fraction (HFpEF) may be less likely than their counterparts with heart failure with reserved ejection fraction (HFrEF) to receive oral anticoagulation, according to a study published in Clinical Cardiology.

Using data from the PINNACLE Registry, Johanna P. Contreras, MD, MSc, FACC, et al., identified 340,127 patients with NVAF and HF (73% with HFpEF vs. 27% with HFrEF). Patients with HFpEF had higher mean CHA2DS2-VASC scores and were less likely to receive anticoagulation (60.6%), compared with HFrEF patients (64.2%).

The researchers conclude that patients with NVAF and HFpEF are significantly less likely to receive oral anticoagulation vs. patients with NVAF and HFrEF, suggesting that HFpEF may be underappreciated as a risk factor for stroke.

Additional research is needed to determine why the differences in anticoagulation use based on HF type exist, they note.

Clinicians With More Experience Less Likely to Adhere to Recent Clinical Guidelines

Providers who have practiced longer, measured by years, may be less likely to adhere to recent evidence-based clinical guidelines and nationally recognized standards, according to a study published in the American Journal of Cardiology.

Kerrilynn Carney, MD, et al., used data from the PINNACLE Registry to examine the relationship between cardiovascular provider experience and compliance with performance measures for outpatients with coronary artery disease, HF and AFib.

The researchers found a significant difference in compliance in four of nine performance measures between providers with different levels of experience.

The findings demonstrate a negative association between performance on cardiovascular quality measures and physician experience in years, but the "clinical significance of this finding is unclear," the researchers conclude.

Additional research is needed to understand the differences between guideline-recommended care and real-world practice of clinicians across their careers, they note.

Keywords: Atrial Fibrillation, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Heart Failure, Blood Pressure, Coronary Artery Disease, Risk Factors, Guideline Adherence, Prevalence, Outpatients, Stroke Volume, Quality Indicators, Health Care, Blood Pressure Determination, Registries, National Cardiovascular Data Registries, PINNACLE Registry


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