Author + information
- Received December 16, 2016
- Accepted December 16, 2016
- Published online March 13, 2017.
- Frederick A. Masoudi, MD, MSPHa,b,∗ (, )
- Angelo Ponirakis, PhDc,
- James A. de Lemos, MDd,
- James G. Jollis, MDe,
- Mark Kremers, MDf,
- John C. Messenger, MDa,
- John W.M. Moore, MD, MPHg,
- Issam Moussa, MDh,
- William J. Oetgen, MD, MBAc,
- Paul D. Varosy, MDi,
- Robert N. Vincent, MD, CMj,
- Jessica Wei, MD, MSc,
- Jeptha P. Curtis, MDk,
- Matthew T. Roe, MD, MHSl and
- John A. Spertus, MD, MPHm
- aDepartment of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- bColorado Cardiovascular Outcomes Research Consortium, Denver, Colorado
- cAmerican College of Cardiology Foundation, Washington, DC
- dDepartment of Medicine, University of Texas Southwestern, Dallas, Texas
- eDepartment of Medicine, University of North Carolina, Chapel Hill, North Carolina
- fNovant Health Heart and Vascular Institute, Charlotte, North Carolina
- gDivision of Cardiology, Department of Pediatrics, Rady Children’s Hospital, University of California–San Diego, San Diego, California
- hDivision of Cardiology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- iVA Eastern Colorado Health Care System, University of Colorado, and Colorado Cardiovascular Outcomes Research Group, Denver, Colorado
- jDivision of Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
- kDepartment of Medicine, Yale University, New Haven, Connecticut
- lDuke Cardiovascular Research Institute, Durham, North Carolina
- mDivision of Cardiovascular Diseases, Mid-America Heart Institute, Kansas City, Kansas
- ↵∗Address for correspondence:
Dr. Frederick A. Masoudi, 12401 East 17th Avenue, Room 522, Campus Box B132, Aurora, Colorado 80045.
- acute coronary syndromes
- congenital heart disease
- implantable cardioverter-defibrillators
- percutaneous coronary intervention
- quality of care
The National Cardiovascular Data Registry (NCDR) of the American College of Cardiology consists of 10 national programs designed to measure quality of care for high-impact cardiovascular conditions and procedures. The NCDR provides feedback with benchmarking of a broad range of quality metrics to participants, supports quality improvement interventions at the local and national level, and serves as the basis for cardiovascular health services and epidemiology research that informs contemporary clinical care. This report provides a summary of key findings from 4 established hospital programs: CathPCI (Diagnostic Catheterization and Percutaneous Coronary Intervention) capturing data on coronary angiography and percutaneous coronary interventions; ACTION-GWTG (Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines) for acute myocardial infarction; ICD (Implantable Cardioverter-Defibrillator) for implantable cardioverter-defibrillators and cardiac resynchronization therapy; and IMPACT (Improving Pediatric and Adult Congenital Treatment) for catheterization procedures for congenital heart disease in children and adults. A more complete report is published separately (1). Data from the ambulatory programs and those focusing on newly adopted technologies will be reported separately or will be included in future reports. The data provided reflect care in 2014 and, in some cases, include temporal trends since 2011. 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.
▪ In 2014, the program collected data on 667,424 patients undergoing percutaneous coronary intervention (PCI), of which 35.3% procedures were performed for elective indications and 64.7% performed for nonelective indications.
▪ A total of 1,612 hospitals submitted data to CathPCI (20% were rural and 34% were teaching hospitals).
▪ Between 2011 and 2014, the use of femoral access declined (from 88.8% to 74.5%) and radial access increased (from 10.9% to 25.2%).
▪ Rates of use of evidence-based therapies, including aspirin, P2Y12 inhibitors, and statins for eligible patients are high (performance for a composite measure of all medications of 89.1% in 2011 and 93.3% in 2014).
▪ In 2014, median door-to-balloon time for primary PCI for ST-segment elevation myocardial infarction (STEMI) was 59 min for patients receiving PCI in the presenting hospital and 105 min for patients transferred from another facility for therapy.
▪ The use of mechanical circulatory support during a PCI procedure was stable between 2011 and 2014 (3.1% in both time periods).
▪ In 2014, the unadjusted rate of acute kidney injury was 2.6% (vs. 2.3% in 2011), of blood transfusion was 1.4% (vs. 1.9% in 2011), of post-procedural stroke was 0.2% (vs. 0.2% in 2011), of emergency coronary artery bypass graft surgery was 0.2% (vs. 0.3% in 2011), and of vascular access site injury was 1.3% (vs. 1.2% in 2011).
▪ In 2014, the program collected data on 158,649 patients receiving an ICD of whom 120,228 received a device for a primary prevention indication and 38,421 for a secondary prevention indication; 91,000 of all procedures represented initial generator implants.
▪ A total of 1,715 hospitals submitted data to the ICD Registry (21% were rural and 36% teaching hospitals); hospital ICD procedural volume ranged from <25 (in 457 participating hospitals) to more than 150 (229 participating hospitals).
▪ Among physicians implanting ICDs, 81.7% were board certified in clinical cardiac electrophysiology or had completed adult or pediatric electrophysiology fellowship.
▪ Of all implants in 2014, 25% involved a single-chamber device, 32% dual-chamber devices, and 43% cardiac resynchronization defibrillators. In 2011, 19% of procedures involved a single-chamber device; 37% employed a dual-chamber device, and 44% were cardiac resynchronization defibrillators.
▪ Rates of use of individual evidence-based therapies are generally high; however, performance on a composite medication metric, including angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for patients with left ventricular systolic dysfunction (LVSD) and beta-blockers for those with LVSD or prior myocardial infarction, was 80.3% in 2014 compared with 76.7% in 2011, identifying an important target for quality improvement.
▪ In 2014, the program collected data on 182,903 patients with acute myocardial infarction, of whom 71,368 had STEMI and 111,535 had non–ST-segment elevation acute coronary syndromes.
▪ A total of 907 hospitals submitted data to ACTION-GWTG; 19% were rural and 36% were teaching hospitals.
▪ Although performance on many measures was high for many metrics, exceptions include overall defect-free care (median hospital performance rate of 78.4% in 2014); P2Y12 inhibitor use in eligible medically-treated patients (56.7%); and the use of aldosterone antagonists in patients with LVSD and either diabetes or heart failure (12.8%).
▪ Among eligible patients with STEMI, 95.8% underwent coronary angiography and 90.7% underwent PCI. Among those with non–ST-segment elevation myocardial infarction (NSTEMI), 81.9% underwent coronary angiography and 52.4% underwent PCI.
▪ Patients with STEMI were more likely to experience certain adverse events during hospitalization compared with those with NSTEMI, including death (6.4% for STEMI, 3.4% for NSTEMI), cardiogenic shock (4.4% vs. 1.6%, respectively), or bleeding (8.5% vs. 5.5%, respectively).
▪ In 2014, the program collected data on 20,169 patients with congenital heart disease undergoing cardiac catheterization or catheter-based intervention, of whom 86.0% were younger than age 18 years and 24.6% were younger than age 1 year.
▪ A total of 76 hospitals submitted data to the IMPACT Registry (19% rural and 36% teaching hospitals).
▪ Many procedures, including atrial septal defect closure, patent ductus arteriosus closure, aortic coarctation stenting, and pulmonary valvuloplasty were performed with success rates exceeding 84%. Aortic coarctation balloon angioplasty was less often successful (55.1%).
▪ Device embolization was reported in 1.2% of atrial septal defect closure procedures and 1.1% of patent ductus arteriosus closure procedures; a clinically significant increase in aortic regurgitation after valvuloplasty was reported in 10.6% of cases.
NCDR programs provide unique opportunities to advance the understanding of care for cardiovascular disease in the United States. These programs collect data for a broad range of patients in geographically and structurally diverse care settings, and they characterize the clinical care and outcomes of patients with high-impact cardiovascular conditions or undergoing common cardiovascular.
Dr. Masoudi has a contract with the American College of Cardiology Foundation for his role as Chief Science Officer of the National Cardiovascular Data Registry. Dr. Ponirakis, Dr. Oetgen, and Ms. Wei are employed by the American College of Cardiology Foundation. Dr. de Lemos has received grant support from Roche Diagnostics and Abbott Diagnostics; has served on endpoint committees for Siemen's Health Care and Radiometer; has received consulting income from Roche Diagnostics; and has received honoraria for participation in the data and safety monitoring board or steering committees of Novo Nordisk, St. Jude Medical, and Amgen. Dr. Kremers has equity (<$20,000) in Boston Scientific; provides consulting for Medtronic; and is a member of the Speakers Bureau for Boston Scientific. Dr. Messenger is an investigator in clinical research studies for Philips Medical Systems; and is a member of the Clinical Events Committee of Novate Medical. Dr. Moore is a consultant for pfm Medical; is an investigator in research protocols funded by Medtronic and St. Jude Medical; and is on the medical advisory boards for 480 BioMedical and Transmural Systems. Dr. Curtis receives salary support through a contract with the American College of Cardiology to provide data analytic services and from the Centers for Medicaid & Medicare Services; and has equity in Medtronic. Dr. Roe has received research funding from Eli Lilly, Sanofi, Daiichi-Sankyo, Janssen Pharmaceuticals, Ferring Pharmaceuticals, Myokardia, AstraZeneca, American College of Cardiology, American Heart Association, and Familial Hypercholesterolemia Foundation; and has received consulting fees or honoraria from PriMed, AstraZeneca, Boehringer Ingelheim, Merck, Actelion, Amgen, Myokardia, Eli Lilly, Novartis, Daiichi-Sankyo, Quest Diagnostics, and Elsevier Publishers. Dr. Spertus is affiliated with the Saint Luke’s Mid America Heart and Institute, which is the major analytic center for the PINNACLE program and receives funding from the American College of Cardiology for this role; is on the Scientific Advisory Board of United Healthcare; provides consulting services for United Healthcare, Novartis, Amgen, and Bayer (all moderate); has copyright to the Kansas City Cardiomyopathy Questionnaire, Seattle Angina Questionnaire, and the Peripheral Artery Questionnaire (significant); has received grants from Gilead, Lilly, Novartis, and Abbott Vascular (all significant); and has equity in Health Outcomes Sciences (significant). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 16, 2016.
- Accepted December 16, 2016.
- 2017 American College of Cardiology Foundation