JACC: NCDRs analysis shows improvement in U.S. MI treatment
Hospitals across the U.S. are making "impressive improvements" in the care of patients who have a heart attack or undergo PCI procedures, according to an analysis of the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR), which appears in the July 20 issue of the Journal of the American College of Cardiology.

A quality improvement program in the U.S., the NCDR comprises data registries that involve more than 2,400 hospitals and more than 10.6 million patient records.

“More patients with heart attacks qualify for urgent angioplasty and stenting, and they are getting it quicker,” said senior author John S. Rumsfeld, MD, PhD, the NCDR’s chief science officer and chair, as well as acting national director of cardiology for the Veterans Affairs Health Administration. “There also have been improvements in giving recommended medications to heart attack patients—many of which reduce the risk of death and long-term complications.”

For the study, researchers drew from two large NCDR registry programs.

They analyzed data from the ACTION Registry–GWTG, a partnership between the ACC and the American Heart Association and includes data on the hospital care of patients with STEMI or NSTEMI. The resulting study group consisted of all 131,980 patients treated for a heart attack at approximately 250 participating hospitals from January 2007 through June 2009.

The data analysis showed significant improvements in several aspects of MI care, including:
  • Increase from 90.8 percent to 93.8 percent in the use of treatments to restore blood flow to the heart in patients with STEMI.
  • Increase from 64.5 percent to 88 percent in the number of patients with STEMI with PCI within 90 minutes of arriving at the hospital—a quality benchmark.
  • Improvement from 89.6 percent to 92.3 percent in overall performance scores that measure timeliness and appropriateness of therapy for STEMI.
  • Improvement in achieving correct dosing of several types of blood thinners among NSTEMI patients.
  • Reduction from 6.2 percent to 5.5 percent in risk-adjusted hospital death rates among STEMI patients and from 4.3 percent to 3.9 percent among NSTEMI patients.
  • Improvement in prescribing guidelines-recommended medications, including aspirin, clopidogrel, statins, beta blockers and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, as well as in counseling patients to stop smoking and referring patients to cardiac rehabilitation.

Patients also are taking important steps toward improving MI care by heeding the warning signs, the data revealed. The time from the beginning of MI symptoms to the patient’s arrival at the hospital dropped significantly during the study period, from 1.7 hours to 1.5 hours, on average.

“Patients are coming to the hospital sooner,” Rumsfeld said. “That shows a greater awareness by the public that if you have unexplained chest pain or shortness of breath, you need to get to the hospital quickly.”

To evaluate PCI trends, investigators analyzed data from the NCDR CathPCI Registry database, which contains hospital data on diagnostic cardiac catheterization and PCI—a partnership between the ACC and the Society for Cardiovascular Angiography and Interventions. The resulting PCI study group consisted of all 1.71 million patients who had PCI from January 2005 through June 2009. During that time, participating hospitals grew from 436 to 959.

The data analysis revealed several notable trends, including:
  • Increase in procedural complexity, including treatment of significantly more patients with challenging type C lesions;
  • Reduction in complications related to bleeding or injury to the arteries;
  • Medication use changes designed to prevent unwanted blood clots, reflecting the results of recent clinical trials and recommendations from new clinical practice guidelines; and
  • Reduction in the overall use of drug-eluting stents, partially balanced by increased use of new types of drug-eluting stents.

The analysis also highlighted specific areas in need of improvement and identified targets for future research, particularly those aimed at reducing the bleeding risks.

“This is direct clinical data from doctors and hospitals themselves on which patients got which treatments and how they did,” Rumsfeld said. “If you want to actually understand the risk of a given patient and match the best treatment to their situation, you need real clinical data.”