NCDR Study Shows Steady Improvement in GDMT Adherence For STEMI, NSTEMI Patients
There were steady improvements in process measures and increased adherence to guideline-directed medical therapy (GDMT) among patients with STEMI and NSTEMI between 2009 and 2018, according to a study published Jan. 18 in Circulation: Cardiovascular Quality and Outcomes.
Sanjay Gandhi, MBBS, MBA, FACC, et al., used data from ACC's Chest Pain – MI Registry to determine annual trends in patient characteristics, treatment and cardiovascular outcomes among STEMI and NSTEMI patients from 2009 to 2018. The researchers also studied in-hospital risk-adjusted mortality trends from 2011 through 2018.
The study included 604,936 STEMI patients and 933,755 NSTEMI patients at 1,230 sites. The number of active sites participating in the registry increased from 281 in 2009 to 817 in 2018. As of 2018, the majority of participating facilities were nonteaching hospitals (82.2%) located in urban areas (80.7%). The proportion of hospitals providing primary PCI without on-site surgery increased from 12.8% in 2009 to 27.8% in 2018.
Over the study period, 39.3% of patients presented with STEMI vs. 60.7% with NSTEMI, with no significant change in the proportion of STEMI to NSTEMI patients (p=0.32). The prevalence of diabetes and atrial fibrillation increased among all patients throughout the study period, while the prevalence of smoking decreased. Use of primary PCI went up among eligible STEMI patients, from 82.3% in 2009 to 96% in 2018, and among NSTEMI patients, from 43.9% to 54.5%. Adherence to GDMT also rose among both STEMI and NSTEMI patients, which contributed to a significant increase in the overall defect free care composite rate. The risk-adjusted mortality rate was stable among STEMI patients between 2011 (2.8%) and 2018 (2.7%) but declined among NSTEMI patients (1.9% in 2011 vs. 1.3% in 2018).
According to the researchers the findings show "steady improvement in process measures and high adherence to GDMT" for STEMI and NSTEMI patients. The Chest Pain – MI Registry "continues to play an important role in performance improvement efforts across the country," they note. Moving forward, future research using data from the Chest Pain – MI Registry "may provide additional insights into opportunities for improving health care delivery and patient outcomes," they conclude.
Keywords: National Cardiovascular Data Registries, Chest Pain MI Registry, Myocardial Infarction, Diabetes Mellitus, Registries, Chest Pain, Atrial Fibrillation, ST Elevation Myocardial Infarction, Non-ST Elevated Myocardial Infarction, Percutaneous Coronary Intervention
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