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A cute C oronary T reatment and I ntervention O utcomes N etwork

“An ACC and AHA? Effort to Improve MI Care” Eric Peterson, MD, MPH, FACC, FAHA Professor of Medicine Director of CV Research Duke Clinical Research Institute. A cute C oronary T reatment and I ntervention O utcomes N etwork. Background.

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A cute C oronary T reatment and I ntervention O utcomes N etwork

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  1. “An ACC and AHA? Effort to Improve MI Care” Eric Peterson, MD, MPH, FACC, FAHA Professor of Medicine Director of CV Research Duke Clinical Research Institute Acute Coronary Treatment and Intervention Outcomes Network

  2. Background • Outcomes of STEMI and NSTEMI can be altered with evidence-based, timely, and safe care. • Yet, studies have shown ACS care is sub-optimal • Gaps between guideline recommendations and practice • Significant care delays (reperfusion Rx in STEMI) • Care disparities (age, gender, race, insurance) • Paradoxical care (failure to treat those most in need) • Safety concerns (excessive dosing)

  3. Acute Medications STEMI vs NSTEMI Use CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

  4. Timely Reperfusion among STEMI Patients Q2 2006 CRUSADE STEMI data

  5. Safety Concerns: Frequency of Excessive Antithrombotic Dosing Alexander KA, et al. JAMA 2005;294:3108-3116

  6. Why is ACTION Needed • Participation in CMS Metrics is just not enough • Fails to capture newer effective therapies (e.g, Class I ACC/AHA guideline treatments) • Doesn’t collect important safety information (dosing) • Limited data on timing of therapies • Lack patient outcomes • Limited performance feedback • Broad QI Interventions increasing all aspects of ACS care is needed to improve patient outcomes

  7. Clinical Trials Concept Guidelines Provider Led Quality Improvement Outcomes Performance Indicators Safe, Effective, Long-term Use Measurement Provider Led QI Works! • Participation in provider-led quality improvement (QI) efforts can improve ACS care! • ACC-GAP • AHA GWTG • NRMI, CRUSADE • Means of QI • Feedback • Motivated local champions • Collaborative sharing of best practices

  8. GAP Results: Changing Practice ** 93% 92% 100% 86% 89% 84% 80% 75% * 80% 68% 65% 53% 60% 40% 20% 0% (267) (406) (106) (146) (139) (173) (159) (226) (112) (209) ASA BB ACE SMOKING CHOL RX * p < 0.05 ** p < 0.01 PRE POST

  9. 1 0.9 0.8 0.7 0.6 Baseline Proportion of Patients 0.5 4-6 Months 0.4 9-12 Months 0.3 0.2 0.1 0 ACE ASA BP Control Rehab/ Ex Beta-blocker Smoking Cessation Lipid Lowering LDL Measurement New England AHA GWTG Pilot Trial 12 Month Results

  10. Composite Adherence Trends in CRUSADE Quarter 1, 2002 through Quarter 2, 2006

  11. Association Between Overall Guidelines Adherence and Mortality Every 10%  in guidelines adherence  10%  in mortality (OR=0.90, 95% CI: 0.84-0.97) Peterson et al, JAMA 2006;295:1863-1912

  12. The ACTION Registry • Represents the merger of the nation’s premier ACS registries: • NRMI (National Registry of Myocardial Infarction) • CRUSADE • ? Soon AHA GWTG CAD • Unified under the leadership and support of NCDR™ : • Guidelines, performance indictor, and data standard alignment • Clinical/Technical/contract Support • Training and orientation

  13. Goals of the ACTION Registry • The nation’s ACS surveillance system • Assess characteristics, treatments, and outcomes of patients hospitalized with STEMI and NSTEMI • Optimize the care and outcomes of ACS patients • Implement ALL evidence-based guideline recommendations in clinical practice • Assure that the right things are done right (safe and timely). • Facilitate efforts to improve ACS care quality & safety via novel QI improvement methods

  14. Registry • No charge for participation • Support provided by • Genentech • BMS and Sanofi • Schering Plough • Data elements • Consistent w AHA/ACC • Data submission • EDC system • Soon multivendor

  15. Current ACTION Site Distribution Active Sites = 290 WA (12) ME (1) VT (0) ND (1) MT (1) MI NH (1) MN (5) NY (10) OR (6) MA (1) WI (6) SD (1) RI (0) ID (1) MI (14) WY (0) CT (2) PA (26) IA (7) NJ (6) NE (4) OH (22) DE (0) NV (0) IL (18) IN (12) WV (1) MD (11) VA (11) UT (0) CO (7) KY (2) MO (8) KS (5) DC (0) CA (15) NC (17) TN (8) SC (3) OK (2) AR (1) AZ (3) NM (0) AL (3) GA (8) MS (5) LA (2) TX (11) FL (9) AK (1) HI (0) Last updated: 1/4/07

  16. ACTION 2007 Cumulative Data Submission Number of records

  17. Complexity of ACS PatientsSTEMI vs. NSTEMI ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

  18. In-Hospital OutcomesSTEMI vs. NSTEMI *Transfusion among non-CABG patients ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

  19. Acute Medications STEMI vs NSTEMI ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 STEMI (n=11,854) NSTEMI (n=26,956)

  20. STEMI – Timing of Reperfusion ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854) DTB = 1st Door to Balloon DTN = 1st Door to Needle for Lytics

  21. Discharge Medications STEMI vs NSTEMI * Ideal Patients ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 STEMI (n=11,854) NSTEMI (n=26,956)

  22. Discharge InterventionsSTEMI vs. NSTEMI ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 STEMI (n=11,854) NSTEMI (n=26,956)

  23. ACTION QI Tool Development • Quarterly Feedback reports • Individualized Gap analysis • On-line Real time summaries • QI tool kits • D2B tool kits • Monthly Web-casts • Regional Group Meetings • TAKE ACTION™ Campaign

  24. How to Join • Download the enrollment file from www. ncdr.com • Complete your enrollment packet and submit the materials to the NCDR • Receive Welcome Kit • Complete online tool tutorial Questions: Call 800-257-4737 Email ncdr@acc.org

  25. Thanks Questions???

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