NCDR Cardiovascular Care Trends

Masoudi FA, Ponirakis A, de Lemos JA, et al.
Trends in U.S. Cardiovascular Care: 2016 Report From 4 ACC National Cardiovascular Data Registries. J Am Coll Cardiol 2016;Dec 23:[Epub ahead of print].

The following are key points to remember about current trends in cardiovascular care, as reported from four American College of Cardiology National Cardiovascular Data Registries:

  1. The National Cardiovascular Data Registry (NCDR) is a quality assessment program for populations of patients with cardiovascular disease (CVD). Data from 2014 for four NCDR hospital quality programs were presented in this report. These programs include: 1) CathPCI for coronary angiography and percutaneous coronary intervention (PCI); 2) ICD for implantable cardioverter-defibrillators; 3) ACTION–GWTG (Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines) for acute coronary syndromes (ACS); and 4) IMPACT (IMproving Pediatric and Adult Congenital Treatment) for cardiac catheterization and intervention for pediatric and adult congenital heart disease.
  2. In 2014, the CathPCI registry was used in more than 90% of PCI-capable hospitals in the United States and included 667,424 patients who underwent PCI (mean age, 64.6 years; standard deviation [SD] ± 12.3; most [86.5%] were white). A history of prior coronary events was common. The median time to primary PCI for patients with ST-segment elevation myocardial infarction (STEMI) was stable between 2011 and 2014. In 2014, 93.5% of eligible patients undergoing PCI received aspirin, P2Y12 inhibitors, and statins compared with 89.1% in 2011. In 2014, nearly all of the PCIs performed for ACS that could be classified were appropriate indications (98.3%). Among patients without ACS, 53.5% were performed for appropriate indications; 32.6% were classified as “may be appropriate” and 13.9% as “rarely appropriate.”
  3. Procedure-related complications were also reported in the CathPCI registry. Between 2011 and 2014, unadjusted rates of acute kidney injury increased (from 2.3% to 2.6%) and rates of blood transfusion declined (from 1.9% to 1.4%). Rates of post-procedural stroke (0.2% in 2014), and the need for emergency coronary artery bypass graft surgery (0.2% in 2014) and vascular access site injury (1.3% in 2014) were relatively stable over time.
  4. The ICD registry includes data on over 1,300,000 records since its inception in 2006. The program is used in all hospitals implanting devices if they provide primary prevention therapy to patients insured by Medicare, given the coverage with evidence decision. The majority of records (81,406 or 51%) were patients with Medicare insurance coverage receiving a device for a primary prevention indication. The mean age of the population was 67.1 years (SD ± 13.2), and 17.2% were at least 80 years old; the majority (82.9%) were white. Most patients (83.4%) had heart failure documented prior to device implantation.
  5. In the ICD registry, most procedures met Class I, IIa, and IIb indications; 88.3% in 2014 compared with 86.2% in 2011. The prescription of evidence-based medications for patients with prior MI and left ventricular systolic dysfunction (LVSD) in 2014 ranged from 83.9% for angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB) for LVSD (compared with 81.2% in 2012), to 94.1% for beta-blocker for LVSD. Performance with respect to a composite medication measure for all these therapies among eligible patients, however, was only 80.3% in 2014, identifying an important target for improvement.
  6. The ACTION–GWTG registry assesses the characteristics, treatments, and outcomes of patients with acute MI (both STEMI and non-STEMI [NSTEMI]). The number of participating hospitals in 2014 was 907, which is estimated to represent 27% of acute care hospitals providing care for AMI. In 2014, 182,903 patients were included in the ACTION-GWTG program, of which 71,368 (39.0%) had STEMI, and 111,535 (61.0%) had NSTEMI. The mean age was 64.6 years (SD ± 13.6), 34.4% were women, and the majority (84.3%) were white. Most patients with STEMI (95.8%) underwent coronary angiography during hospitalization; the proportion of patients with NSTEMI undergoing angiography was 81.9%.
  7. While the performance of centers in the 90th percentile was uniformly excellent, important opportunities for improvement were identified. These included evaluation of LV ejection fraction during hospitalization, prescription of an ACE inhibitor or ARB at discharge among patients with MI and LVSD, and referral to cardiac rehabilitation. Errors in dosing of anticoagulant and antiplatelet agents, particularly unfractionated heparin, were relatively common and represent an important target for protocols.
  8. The IMPACT registry was designed to assess the prevalence, demographics, management, and outcomes of pediatric patients and adult patients with congenital heart disease who undergo diagnostic catheterization-based interventions. In 2014, IMPACT collected data on procedures for 20,169 patients. Almost half (46.4%) were female, and 86% were younger than 18 years old; 71.2% were white. IMPACT was used in 76 hospitals, which is estimated to represent 57% of hospitals that provide interventional services for patients with congenital heart disease. Success rates for selected procedures included closures of atrial septal defects and patent ductus arteriosus in over 94%; rates of success for pulmonary valvuloplasty (84.3%), aortic coarctation stenting (87.4%), and aortic coarctation balloon angioplasty (55.1%) were lower. With respect to adverse procedural events, device embolization during atrial septal defect (1.2%) and patent ductus arteriosus (1.1%) occurred rarely; increases in aortic regurgitation after balloon valvuloplasty were 10.6%.

Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Dyslipidemia, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Anticoagulation Management and ACS, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Prevention, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Interventions and ACS, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Arrhythmias, Cardiac, Heart Defects, Congenital, Geriatrics, Heart Failure, Angiography, Acute Kidney Injury, Angioplasty, Balloon, Coronary, Angiotensin-Converting Enzyme Inhibitors, Anticoagulants, Aortic Coarctation, Aspirin, Cardiac Catheterization, Coronary Angiography, Coronary Artery Bypass, Defibrillators, Implantable, Ductus Arteriosus, Patent, Heart Septal Defects, Atrial, Heparin, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medicare, National Cardiovascular Data Registries, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Primary Prevention, Stroke

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