PINNACLE Registry QI Program in India: A Model For Other Resource-Limited Countries?

This post was authored by Nathan Glusenkamp, MA, director of the PINNACLE Program and William J. Oetgen, MD, MBA, FACC, executive vice president of the ACC's Publication, Education, Science & Quality.

Today marks a seminal event in the evolution of the PINNACLE Registry with the publication of an article in the Journal of the American Heart Association. “Cardiovascular Disease Performance Measures in the Outpatient Setting in India: Insights from the American College of Cardiology’s PINNACLE India Quality Improvement Program (PIQIP)” is the first published report from PIQIP, an international project within the PINNACLE Registry program that has been ongoing for the past three years.

The PIQIP effort is designed to assist cardiologists practicing in India to evaluate the quality of the cardiovascular care that their patients receive. Built on the PINNACLE platform, the PIQIP collects data from individual patient encounters that allow calculation of performance measures related to three disease states: coronary artery disease, heart failure, and atrial fibrillation. The lead author of the study is Ankur Kalra, MD, who is a cardiologist in the Division of Cardiology, Department of Medicine, Kalra Hospital in New Delhi, India. The senior author is Salim S. Virani, MD, PhD, FACC, of the Health Policy, Quality & Informatics Program, Michael E. DeBakey Veteran Affairs Medical Center Health Services Research and Development Center for Innovations, in Houston, Texas.

PIQIP was designed to address the increasing burden on cardiovascular disease in India by collecting data on the quality of care given in the outpatient setting. It represents the first international expansion of the PINNACLE Registry program.

In the study, the authors report data collected from ten outpatient treatment sites in west-central and central India, including four major cities – Mumbai, Hyderabad, Ahmedabad, and Pune. There were 115 cardiologists participating, and 68,196 unique patients seen in 155,953 encounters. More than 75 percent of the patients in the study were aged less than 65 years, and 70 percent were male. The mean blood pressure was 126/78, and the mean body mass was 25.8 kg/m2.

Among the patients studied, hypertension was the most prevalent diagnosis (30 percent), followed by coronary artery disease (15 percent), diabetes (15 percent), tobacco use (8 percent), dyslipidemia (7 percent), heart failure (4 percent), and atrial fibrillation (1 percent).

Medication prescriptions among eligible patients were found to be: aspirin (49 percent), clopidogrel (37 percent), and statins (51 percent) in patients with coronary artery disease; renin-angiotensin-aldosterone system antagonists (62 percent) and betablockers (58 percent) of patients with heart failure, and oral anticoagulants (37 percent) in patients with atrial fibrillation.

These baseline data will allow treating cardiologists to develop quality interventions to improve the care of patients with common cardiovascular medical conditions. This report from the PIQIP Registry demonstrates the feasibility of studying outpatient cardiovascular care in the second most populous country in the world, and it also documents the favorable results achievable from a strong collaboration between treating cardiologists in India and the ACC.

The PIQIP research team is currently working on four manuscripts reporting more in-depth analyses of patients with atrial fibrillation, coronary artery disease, diabetes mellitus. They are also exploring the gender gap noted in this initial analysis of PIQIP data.

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