Data From ACC Registries Highlight National Trends in Heart Disease Treatments
January 23, 2017—The American College of Cardiology (ACC) announced the publication of a broad report on trends in heart disease care from the ACC's National Cardiovascular Data Registry (NCDR). The report by Frederick A. Masoudi, MD, et al, which is available online in Journal of the American College of Cardiology (JACC), provides insights into the patient populations, participating centers, and patterns of care based on the 2014 data from four of the 10 NCDR programs: CathPCI Registry, ICD Registry, ACTION Registry-GWTG, and IMPACT Registry.
In the ACC announcement, Dr. Masoudi, who serves as the NCDR Management Board Chair, commented, “We were able to report on the care and outcomes of patients undergoing common cardiovascular procedures, including percutaneous coronary interventions (PCIs), implantable defibrillators, and interventions for congenital heart disease, as well as for patients with acute heart attacks. In some cases, hospitals are consistently providing excellent care; the registries, however, allow us to identify those aspects of care where the cardiovascular clinical community can improve.”
In a corresponding executive summary also published in JACC, Dr. Masoudi said, “NCDR data provide a unique, clinically rich national perspective on the care and outcomes of high-impact cardiovascular conditions and procedures that are not available elsewhere.”
The ACC advised that the report shows that more than 93% of heart attack patients undergo stenting within the guideline-recommended threshold of 90 minutes after arriving at the hospital, with a median time to stenting of only 59 minutes. The registry data provide unique perspectives into the treatments and outcomes of heart disease care in the United States and illustrate the strength of national quality programs, like NCDR, in advancing the safety and effectiveness of treatments for heart disease patients, stated the report's authors.
As summarized by ACC, the key findings from each registry include:
- Of the 667,424 patients undergoing PCI in 2014, 35.3% of PCIs were performed for elective indications; 64.7% were performed for nonelective indications.
- Between 2011 and 2014, the use of femoral access declined from 88.4% to 74.5%; the use of radial access increased from 10.9% to 25.2%.
- Use of evidence-based therapies, including aspirin, P2Y12 inhibitors, and statins for eligible patients, continues to remain high at 93.3%.
- Median door-to-balloon time for primary PCI for ST-elevation myocardial infarction (STEMI) also remains strong at 59 minutes for patients undergoing PCI at the presenting hospital and 105 minutes for transfer patients.
- Of the 158,649 patients undergoing implantable cardioverter defibrillator (ICD) therapy in 2014, 120,228 received a device for primary prevention reasons; 38,421 received a device for secondary prevention indications.
- Of all ICD implants in 2014, 25% involved single-chamber devices, 32% involved dual-chamber devices, and 43% involved cardiac resynchronization therapy devices compared to 19%, 37%, and 44% in 2011, respectively.
- Although the use of evidence-based therapies are generally high, performance on a composite medication metric, including use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers for patients with left ventricular systolic dysfunction (LVSD) and beta blockers for patients with LVSD, could be a target for quality improvement efforts. Between 2011 and 2014, the composite rate of use grew from 76.7% to 80.3%, with room for continued improvement.
- Of the 182,903 patients with acute myocardial infarction in 2014, 71,368 had STEMI; 111,535 had non-STEMI (NSTEMI) syndromes.
- There is room for improvement in the areas of overall defect-free care (78.4%), P2Y12 inhibitor use in eligible patients (56.7%), and use of aldosterone antagonists in patients with LVSD and either diabetes or heart failure (12.8%).
- Compared to NSTEMI patients, STEMI patients were more likely to experience certain adverse events during hospitalization, including death (6.4% vs 3.4%), cardiogenic shock (4.4% vs 1.6%), or bleeding (8.5% vs 5.5%).
- Of the STEMI patients, 95.8% underwent coronary angiography, and 90.7% underwent PCI. Of the NSTEMI patients, 81.9% underwent coronary angiography, and 52.4% underwent PCI.
- Of the 20,169 patients with congenital heart disease undergoing cardiac catheterization or a catheter-based intervention, 86% were younger than 18 years, and 24.6% were less than 1 year old.
- Procedures such as atrial septal defect (ASD) closure, patent ductus arteriosus (PDA) closure, aortic coarctation stenting, and pulmonary valvuloplasty had success rates exceeding 84%. Aortic coarctation balloon angioplasty was less successful at 55.1%.
- Device embolization was reported in 1.2% of ASD closure procedures and 1.1% of PDA closure procedures. A clinically significant increase in aortic regurgitation following valvuloplasty was noted in 10.6% of cases.