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“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

“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

background
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)
acute medications stemi vs nstemi use
Acute Medications STEMI vs NSTEMI Use

CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)

timely reperfusion among stemi patients
Timely Reperfusion among STEMI Patients

Q2 2006 CRUSADE STEMI data

safety concerns frequency of excessive antithrombotic dosing
Safety Concerns: Frequency of Excessive Antithrombotic Dosing

Alexander KA, et al. JAMA 2005;294:3108-3116

why is action needed
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
provider led qi works

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
slide8

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

slide9

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

composite adherence trends in crusade
Composite Adherence Trends in CRUSADE

Quarter 1, 2002 through Quarter 2, 2006

slide11

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

the action registry
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
goals of the action registry
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
slide14
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
current action site distribution
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

complexity of acs patients stemi vs nstemi
Complexity of ACS PatientsSTEMI vs. NSTEMI

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

in hospital outcomes stemi vs nstemi
In-Hospital OutcomesSTEMI vs. NSTEMI

*Transfusion among non-CABG patients

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

acute medications stemi vs nstemi
Acute Medications STEMI vs NSTEMI

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

STEMI (n=11,854) NSTEMI (n=26,956)

slide20

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

discharge medications stemi vs nstemi
Discharge Medications STEMI vs NSTEMI

* Ideal Patients

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

STEMI (n=11,854) NSTEMI (n=26,956)

discharge interventions stemi vs nstemi
Discharge InterventionsSTEMI vs. NSTEMI

ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007

STEMI (n=11,854) NSTEMI (n=26,956)

action qi tool development
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
how to join
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 [email protected]

thanks
Thanks

Questions???

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