Author + information
- Received April 26, 2013
- Accepted May 7, 2013
- Published online November 19, 2013.
- Frederick A. Masoudi, MD, MSPH∗,†∗ (, )
- Angelo Ponirakis, PhD‡,
- Robert W. Yeh, MD§,
- Thomas M. Maddox, MD, MSc∗,†,||,
- Jim Beachy, RCIS‡,
- Paul N. Casale, MD¶,
- Jeptha P. Curtis, MD#,
- James De Lemos, MD∗∗,
- Gregg Fonarow, MD††,
- Paul Heidenreich, MD, MS‡‡,
- Christina Koutras, RN‡,
- Mark Kremers, MD§§,
- John Messenger, MD∗,
- Issam Moussa, MD||||,
- William J. Oetgen, MD, MBA‡,
- Matthew T. Roe, MD, MHS¶¶,
- Kenneth Rosenfield, MD§,
- Thomas P. Shields Jr., BA‡,
- John A. Spertus, MD, MPH##,
- Jessica Wei, MS‡,
- Christopher White, MD∗∗∗,
- Christopher H. Young, PhD††† and
- John S. Rumsfeld, MD, PhD∗,†,||
- ∗Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- †Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado
- ‡American College of Cardiology Foundation, Washington, DC
- §Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- ||Department of Medicine, VA Eastern Colorado Health Care System, Denver, Colorado
- ¶The Heart Group of Lancaster General Health, Lancaster, Pennsylvania
- #Department of Medicine, Yale University, New Haven, Connecticut
- ∗∗Department of Medicine, University of Texas Southwestern, Dallas, Texas
- ††Department of Medicine, University of California-Los Angeles Medical Center, Los Angeles, California
- ‡‡Department of Medicine, Veterans Affairs Palo Alto Medical Center, Palo Alto, California
- §§Mid Carolina Cardiology and Presbyterian Hospital, Charlotte, North Carolina
- ||||Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida
- ¶¶Duke Cardiovascular Research Institute, Durham, North Carolina
- ##Division of Cardiovascular Diseases, Mid-America Heart Institute, Kansas City, Kansas
- ∗∗∗Department of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, Louisiana
- †††The Moran Company, Arlington, Virginia
- ↵∗Reprint requests and correspondence:
Dr. Frederick A. Masoudi, Campus Box B132, 12401 East 17th Avenue, Room 522, Aurora, Colorado 80045.
Objectives The aim of this report was to characterize the patients, participating centers, and measures of quality of care and outcomes for 5 NCDR (National Cardiovascular Data Registry) programs: 1) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With The Guidelines) for acute coronary syndromes; 2) CathPCI Registry for coronary angiography and percutaneous coronary intervention; 3) CARE (Carotid Artery Revascularization and Endarterectomy) Registry for carotid revascularization; 4) ICD Registry for implantable cardioverter defibrillators; and the 5) PINNACLE (Practice INNovation And CLinical Excellence) Registry for outpatients with cardiovascular disease (CVD).
Background CVD is a leading cause of death and disability in the United States. The quality of care for patients with CVD is suboptimal. National registry programs, such as NCDR, permit assessments of the quality of care and outcomes for broad populations of patients with CVD.
Methods For the year 2011, we assessed for each of the 5 NCDR programs: 1) demographic and clinical characteristics of enrolled patients; 2) key characteristics of participating centers; 3) measures of processes of care; and 4) patient outcomes. For selected variables, we assessed trends over time.
Results In 2011 ACTION Registry–GWTG enrolled 119,967 patients in 567 hospitals; CathPCI enrolled 632,557 patients in 1,337 hospitals; CARE enrolled 4,934 patients in 130 hospitals; ICD enrolled 139,991 patients in 1,435 hospitals; and PINNACLE enrolled 249,198 patients (1,436,328 individual encounters) in 74 practices (1,222 individual providers). Data on performance metrics and outcomes, in some cases risk-adjusted with validated NCDR models, are presented.
Conclusions The NCDR provides a unique opportunity to understand the characteristics of large populations of patients with CVD, the centers that provide their care, quality of care provided, and important patient outcomes.
The NCDR (National Cardiovascular Data Registry) comprises 7 distinct quality measurement and improvement programs developed by the American College of Cardiology Foundation (ACCF), often in collaboration with partner organizations. The mission of the NCDR is to improve the quality of cardiovascular patient care by measuring adherence to performance metrics, providing direct feedback to participating sites together with knowledge and tools to improve performance; implementing quality initiatives; and supporting research that improves patient care and outcomes. The primary aim of the registries is to optimize the management and outcomes of patients with cardiovascular disease by collecting and reporting data to improve the quality and safety of care through the provision of risk-adjusted outcomes for benchmarking and novel quality improvement methods. The first NCDR program, the CathPCI Registry, was launched in 1998 and has collected detailed clinical information on nearly 10 million coronary angiography and percutaneous coronary intervention (PCI) procedures performed in the United States (1). The NCDR has subsequently expanded to include 6 additional registries across the spectrum of cardiovascular disease.
The process for developing the core registry datasets follows an established methodology for creating and implementing specific data standards. Committees of experts from multiple disciplines, reflecting both quality improvement and research priorities, identify key data elements and metrics to assess the quality of care for a specified patient population. These data elements and definitions are then subjected to review and iterative refinement, which includes a ranking process, a public comment period, and alpha and beta site review to establish feasibility, until consensus is reached on the final data elements and definitions. Upon completion of the final dataset and data dictionary, a data collection form is designed and tested. Datasets are regularly revised to reflect current clinical practice and ongoing scientific relevance. Data are collected by participants for entry into central data repositories maintained by the ACCF. The NCDR applies a comprehensive data quality program to enhance the validity and reliability of registry data (2). Key performance metrics are supplied to all participants on a quarterly basis accompanied by an explanation of the benchmarking methodology used to facilitate comparison of the outcomes of one institution with results nationally.
The objective of this report is to provide a description and overview of the patient populations, participating centers, and patterns of care from the 5 NCDR registries for which comprehensive data from 2011 are available. Two recently initiated registries (Improving Pediatric and Adult Congenital Treatment, and the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registries) are not included. This report primarily focuses on data from 2011, while also illustrating temporal trends in some patient and care characteristics. Where available, the report highlights similar data elements and outcomes across the registries.
The NCDR ACTION Registry–GWTG
The ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry–GWTG (Get With The Guidelines) is sponsored by the ACCF in conjunction with the American Heart Association, with partnering support from the Society of Cardiovascular Patient Care, The American College of Emergency Physicians, and The Society of Hospital Medicine (3). The ACTION Registry–GWTG was designed to assess the characteristics, treatments, and outcomes of acute myocardial infarction (AMI) patients (either ST-segment elevation myocardial infarction or non–ST-segment elevation myocardial infarction). Eligible patients are those older than 18 years of age hospitalized with a diagnosis of AMI who have acute ischemic symptoms within 24 h of presentation. Patients admitted for other conditions who subsequently develop AMI during hospital stay are not included (Figs. 1 to 6⇓⇓⇓⇓⇓⇓, Tables 1 to 6⇓⇓⇓⇓⇓⇓).
The NCDR CathPCI Registry
The CathPCI Registry is sponsored by ACCF in conjunction with the Society for Cardiovascular Angiography and Interventions. The CathPCI Registry was designed to create a national surveillance system to assess the characteristics, treatments, and outcomes of patients with coronary heart disease who undergo procedures in cardiac catheterization laboratories. The CathPCI Registry does not mandate data collection for all angiographies, although it does require inclusion of all consecutive PCIs. Approximately two-thirds of participating sites submit some data on both diagnostic catheterization and PCI; and one-third submits data for PCI only (4). Eligible patients are adults (18 years of age and older) who undergo a diagnostic cardiac catheterization and/or PCI. For diagnostic catheterization, eligible procedures include catheterization with the passage of a catheter into the aortic root for pressure measurements and/or angiography and can include left ventricular pressure measurements, left ventricular angiography, coronary angiography, and coronary artery bypass angiography. For PCI, eligible procedures include those that involve passage or attempted passage of a device across 1 or more coronary lesion(s) for the purpose of increasing the intraluminal diameter of the vessel and/or restoring or improving circulation (Figs. 7 to 13⇓⇓⇓⇓⇓⇓⇓, Tables 7 to 10⇑⇓⇓⇓).
The NCDR CARE Registry
The CARE (Carotid Artery Revascularization and Endarterectomy) Registry is sponsored by ACCF in conjunction with the Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, American Academy of Neurology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, Society for Vascular Medicine, and Society of Vascular and Interventional Neurology. The CARE Registry was designed to create a national surveillance system to assess the prevalence, demographic data, management, and outcomes of patients undergoing carotid stenting or carotid endarterectomy. Eligible patients are adults undergoing carotid artery stenting (CAS) and/or carotid endarterectomy (CEA) for the purpose of stroke prevention (Figs. 14 to 19⇓⇓⇓⇓⇓⇓, Tables 11 to 13⇓⇓⇓).
The NCDR ICD Registry
The NCDR ICD Registry is sponsored by the ACCF in conjunction with the Heart Rhythm Society. In January 2005, the Centers for Medicaid and Medicare Services (CMS) expanded coverage of implantable cardioverter defibrillators (ICDs) based on the results of 3 major published randomized controlled trials (5). Concurrently, CMS mandated a national database for Medicare patients receiving ICDs for primary prevention. In response to this mandate, the NCDR developed the ICD Registry to assess the characteristics, care, and outcomes of patients undergoing ICD placement at participating centers to determine whether the randomized controlled trial findings could be applied to the general population and to provide additional insights on outcomes after ICD insertion in subpopulations of particular interest (6). Eligible patients for inclusion in the ICD Registry are all adults and pediatric patients undergoing ICD insertion. The CMS mandates that all Medicare beneficiaries receiving an ICD for primary prevention are included in the Registry (Figs. 20 to 25⇓⇓⇓⇓⇓⇓⇓⇓⇓, Tables 14 to 16⇓⇓⇓).
The NCDR PINNACLE Registry
The PINNACLE (Practice INNovation And CLinical Excellence) Registry is dedicated to the quality improvement of cardiovascular medical care provided in the outpatient setting (7). The PINNACLE Registry enables the systematic collection of clinical performance measurement data for patients with coronary artery disease, heart failure, atrial fibrillation, and hypertension. The selected outpatient performance measures are endorsed by the ACCF and American Heart Association and have also been promoted by the Physician Consortium for Performance Improvement of the American Medical Association, the Centers for Medicare and Medicaid Physician Quality Reporting System program, and the National Quality Forum. The diseases and conditions measured in the PINNACLE Registry comprise the vast majority of the clinical activity of cardiovascular specialists and a substantial portion of the clinical activity of primary care providers. The PINNACLE Registry Report includes practice performance for the individual practice compared with the national average for all practices in the Registry, for the site locations within each practice compared with each other and with the practice average, as well as for individual physicians compared with each other and with the practice average (Figs. 26 to 31⇓⇓⇓, Tables 17 to 19⇓⇓⇓).
The NCDR programs provide unique opportunities to advance the understanding of the clinical characteristics, care, and outcomes of patients with cardiovascular disease. Every year, these programs collect data for a broad range of patients undergoing cardiovascular procedures or in the outpatient setting in geographically and structurally diverse care settings. The registry programs are able to characterize the extent of use of evidence-based cardiovascular therapies and the outcomes of these patients.
The authors thank Susan Rogers, RN, MSN, Joan Michaels, RN, MSN, Tony Hermann, RN, MBA, Katie Kehoe, RN, MS, Traci Connolly, RN, MS, Susan Fitzgerald, RN, MS, and Kristyne McGuinn for assistance in compiling these data.
Dr. Masoudi has a contract with the American College of Cardiology Foundation (ACCF) for his role as Senior Medical Officer of the NCDR (National Cardiovascular Data Registry). Dr. Ponirakis, Mr. Beachy, Mrs. Koutras, Dr. Oetgen, Mr. Shields, and Ms. Wei are employed by the American College of Cardiology Foundation (ACCF). Dr. Maddox is Chair of the PINNACLE (Practice INNovation And CLinical Excellence) Registry Research & Publication Committee and is funded by a VA Health Services Research & Development Career Development Award. Dr. Casale is the Chair of the PINNACLE Registry Steering Committee. Dr. Curtis receives salary support through a contract with the American College of Cardiology to provide data analytic services, salary support under contract with Centers for Medicaid and Medicare Services to develop and maintain quality measures, reports stock holding in Medtronic, and has received research funding from Boston Scientific. Dr. De Lemos receives grant support from Roche Diagnostics and Abbott Diagnostics; consulting fees from Janssen Pharmaceuticals; and honoraria from Astra Zeneca and BMS. Dr. Fonarow receives research support from the Agency for Healthcare Research and Quality; serves as a consultant for Novartis, Medtronic, and Gambro; and has served as unpaid Chair of the ACTION Registry-GWTG Steering Committee. Dr. Kremers has equity >$10K in Boston Scientific; provides consulting for Medtronic; is a member of the Speakers’ bureau for Boston Scientific; and is an investigator for St. Jude Medical, Medtronic, Boston Scientific, and Cameron Health. Dr. Messenger is Chair of the CathPCI Registry Research and Publication Committee. Dr. Moussa is an investigator on research protocols sponsored by Medtronic, Gilead, Baxter, and Terumo. Dr. Roe has received research funding from Eli Lilly, Revalesio, Sanofi-Aventis, American College of Cardiology, American Heart Association; and consulting fees or honoraria from AstraZeneca, Sanofi-Aventis, Janssen Pharmaceuticals, Merck, Regeneron, and Daiichi-Sankyo. Dr. Rosenfield has received research grants from Abbott Vascular, Atrium, Lutronix-Bard, Baxter, and IDEV; has received consulting/advisory board fees from Abbott Vascular, Complete Conference Management, Endospan, Micell and Vortex-AngioDynamics; has equity in CardioMEMs, Contego, Embolitech, Icon, Micell, Primacea, and Vortex; and has served on the board of directors for VIVA Physicians (501C3). Dr. Spertus is affiliated with the Saint Luke’s Mid America Heart and Institute, which is the major analytic center for the PINNACLE Registry; receives funding from the American College of Cardiology for this role; is on the Scientific Advisory Board of United Healthcare; and reports a financial relationship with Health Outcomes Sciences. Dr. Rumsfeld has a contract with the ACCF for his role as the Chief Medical Officer of the NCDR. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Abbreviations and Acronyms
- acute myocardial infarction
- carotid artery stenting
- Centers for Medicaid and Medicare Services
- implantable cardioverter defibrillator
- percutaneous coronary intervention
- Received April 26, 2013.
- Accepted May 7, 2013.
- 2013 American College of Cardiology Foundation
- Moussa I.,
- Hermann A.,
- Messenger J.C.,
- et al.
- Messenger J.C.,
- Ho K.K.,
- Young C.H.,
- et al.
- Peterson E.D.,
- Roe M.T.,
- Chen A.Y.,
- et al.
- Peterson E.D.,
- Dai D.,
- DeLong E.R.,
- et al.