Author + information
- Received July 18, 2016
- Revision received December 8, 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, University of Colorado Anschutz Medical Campus, Department of Medicine, 12401 East 17th Avenue, Room 522, Campus Box B132, Aurora, Colorado 80045.
Cardiovascular disease is a leading cause of death and disability in the United States. National programs, such as the National Cardiovascular Data Registry, facilitate assessments of the quality of care and outcomes for broad populations of patients with cardiovascular disease. This report provides data for 2014 from 4 National Cardiovascular Data Registry hospital quality programs: 1) CathPCI (Diagnostic Catheterization and Percutaneous Coronary Intervention) for coronary angiography and percutaneous coronary intervention (667,424 procedures performed in 1,612 hospitals); 2) ICD Registry for implantable cardioverter-defibrillators (158,649 procedures performed in 1,715 hospitals); 3) ACTION–GWTG (Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines) for acute coronary syndromes (182,903 patients admitted to 907 hospitals); and 4) IMPACT (Improving Pediatric and Adult Congenital Treatment) for cardiac catheterization and intervention for pediatric and adult congenital heart disease (20,169 procedures in 76 hospitals). The report provides perspectives on the demographic and clinical characteristics of enrolled patients, characteristics of participating centers, and selected measures of processes and outcomes of care in these programs.
- acute coronary syndromes
- congenital heart disease
- implantable cardioverter-defibrillators
- percutaneous coronary intervention
- quality of care
The mission of the American College of Cardiology’s (ACC’s) NCDR (National Cardiovascular Data Registry) is to improve the quality of cardiovascular care by measuring adherence to performance metrics, establishing the foundation for new metrics, providing direct feedback to participating sites together to improve performance, implementing quality initiatives, and supporting research that improves patient care and outcomes. NCDR data provide a U.S. national perspective on the care and outcomes of high-impact cardiovascular conditions and procedures that are not available elsewhere.
The first NCDR program, CathPCI (Diagnostic Catheterization and Percutaneous Coronary Intervention), was launched in 1998, and has collected detailed clinical information on more than 17.5 million coronary angiography and percutaneous coronary intervention (PCI) procedures performed in the United States since that time (1). The NCDR has subsequently expanded to include 10 programs across the spectrum of cardiovascular disease. Of these, 8 are hospital-based, including: CathPCI, ICD (Implantable Cardioverter Defibrillator), ACTION–GWTG (Acute Coronary Treatment and Intervention Outcomes Network–Get With The Guidelines), IMPACT (Improving Pediatric and Adult Congenital Treatment), LAAO (Left Atrial Appendage Occlusion), PVI (Peripheral Vascular Intervention), AFib Ablation (Atrial Fibrillation Ablation), and the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry (2). The remaining 2 are outpatient programs for the ambulatory care setting, including PINNACLE (Practice Innovation and Clinical Excellence) and the DCR (Diabetes Collaborative Registry) (3). NCDR programs have also been implemented internationally, supporting quality improvement in health systems outside of the United States.
This report provides a description and overview of the patient populations, participating centers, patterns of care, and outcomes from 4 NCDR hospital quality programs (CathPCI, ICD, ACTION–GWTG, and IMPACT) for which comprehensive data from 2014 are available (Central Illustration), similar to a prior report summarizing 2011 data (4). As PVI replaced CARE (Carotid Artery Revascularization and Endarterectomy) in 2014, PVI data will be presented in a future report. Data from recently initiated programs (AFib Ablation and LAAO) will be presented in future reports as data become available; those from the outpatient programs (PINNACLE and the DCR) will be presented separately. STS/ACC TVT Registry data have been published recently (5). This report is intended to provide a national perspective on the quality of cardiovascular care for common procedures, and to inform clinical practice and health policy. Although NCDR programs include international participants, the summary data from this report are limited to those submitted by U.S. participants.
NCDR Program Methods
Program datasets are developed using an established methodology and explicit data definitions. Committees of experts from multiple disciplines and professional societies, with expertise in clinical care, quality improvement, and health services research identify key data elements and define metrics to assess the quality of care. Proposed data elements and definitions undergo review and iterative refinement, which includes a ranking process and public comment period. 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 repositories maintained by the ACC. The NCDR applies a comprehensive data quality program to enhance data validity and reliability (6). This program focuses on data completeness, consistency, and accuracy. All data submitted by participating hospitals are subjected to a Data Quality Report process, which applies criteria for data field completeness and consistency (i.e., assessments for implausible outlier values). Transactional steps during the construction of datasets for analytic purposes further ensure data consistency. Finally, audits are conducted on an annual basis to assess data validity and reliability. Sites are selected either at random or as the result of “outlier analysis” that identifies patterns that may be indicative of inconsistent data entry. This audit emphasizes on data elements that are required to calculate performance metrics or that are used in risk-adjustment outcome models.
All program metrics are on the basis of ACC/American Heart Association (AHA) guidelines. Many are adopted directly from ACC/AHA Performance Measures documents. Others are recommended by the individual registry steering committees, and are developed by the NCDR Measures and Risk Adjustment Subcommittee. Measures developed by NCDR are subject to a 30-day open comment period, and are reviewed and approved by the NCDR Science and Quality Oversight Committee. Performance measures are a subset of metrics meeting the criteria for inclusion in accountability programs (e.g., public reporting) (7). Others are considered quality metrics, which are those measures that are not currently considered suitable for accountability, but that are useful for quality improvement purposes. When available, the NCDR also reports ACC appropriate use criteria, which provide feedback on the extent to which procedures are performed according to evidence-based clinical parameters.
Applications of NCDR Data
Since 1998, NCDR programs have provided a mechanism for centers to identify opportunities for quality improvement on the basis of evidence-based performance feedback that includes national benchmarks. Key performance metrics are provided to participating hospitals, accompanied by an explanation of the benchmarking methodology used to facilitate comparison of 1 institution’s outcomes to national results. Using these data, hospitals can identify gaps in their care, as well as understand the performance that can be achieved in other participating centers in the United States. NCDR hospital programs are now used in more than 2,000 U.S. health care facilities; thus, in many cases, the benchmarks reported by the programs can be considered accurate reflections of care provided across the United States. The NCDR also has an increasing international presence.
The NCDR participates in statewide and nationwide quality reporting initiatives. Program metrics are used by a number of payers, as well as by several U.S. states as part of efforts to assess and ensure quality within their jurisdictions (8,9). The ACC has initiated a voluntary hospital-level public reporting program (10,11) that includes performance measures from the CathPCI and ICD programs available on the ACC CardioSmart patient web site (12). The measures used in this voluntary program are only those that satisfy the reliability and validity criteria for the purposes of accountability. To this point, all measures used in the NCDR public reporting program have been endorsed by the National Quality Forum. U.S. News & World Report also includes NCDR participation in its Best Hospital Rankings. Specifically, hospitals that participate in the NCDR public reporting program receive credit in the Best Hospitals in Cardiology & Heart Surgery rankings (13). Participation in the IMPACT registry results in credit in the Children’s Cardiology and Heart Surgery specialty rankings (14). Thus, the evidence-based metrics developed by the NCDR have become established as national standards for cardiovascular care.
The NCDR also supports generalizable health services, outcomes, and policy research. Each contributes to the broader understanding of cardiovascular care in the United States and illustrates the power of the large community of NCDR participants to collectively improve cardiovascular health. The NCDR has been used to elucidate myriad aspects of care and outcomes in contemporary practice across the registries. Recent examples include procedural success and complications after pulmonary artery stenting from IMPACT (15), observational comparative effectiveness of cardiac resynchronization therapy defibrillator versus ICD in patients with chronic kidney disease from ICD (16), or outcomes of interventions for chronic total occlusions from CathPCI (17). Risk models from the NCDR have been developed for death (18), bleeding (19), and acute kidney injury (20), allowing clinicians to target more intensive risk reduction strategies to the highest-risk patients (21). The NCDR programs have generated insights into the appropriateness of cardiovascular procedures (22); analysis of trends from the CathPCI program suggest that the benchmarking and feedback of procedural appropriateness has resulted in meaningful improvements in patient selection for procedures (23). The NCDR also contributes to the science of quality of care, including assessment of the validity of the program outcome metrics (24) or the potential effect of new practice guidelines on clinical care (25,26).
NCDR CathPCI program
The CathPCI Registry is sponsored by the American College of Cardiology Foundation (ACCF) in conjunction with the Society for Cardiovascular Angiography and Interventions. CathPCI was designed to create a national surveillance system to assess the characteristics, treatments, and outcomes of patients who undergo procedures, including coronary angiography and PCI, in cardiac catheterization laboratories. From its inception in 1998 to the end of 2014, CathPCI included over 17.6 million records. The program does not mandate data collection for all angiography procedures, but does require inclusion of all PCIs. In 2014, CathPCI was used in more than 90% of PCI-capable hospitals in the United States. Currently, 70% of sites submit data for all diagnostic catheterization and PCI procedures; the remaining 30% of sites provide all PCI procedures and the associated diagnostic catheterizations, but do not include all “diagnostic-only” procedures (1). Eligible patients are adults (18 years of age and older) undergoing a qualifying procedure. 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 (LV) pressure measurements, LV angiography, coronary angiography, and coronary artery bypass angiography. For PCI, eligible procedures include those where PCI was attempted and/or performed, defined by the introduction of a guidewire for the purpose of achieving mechanical revascularization.
In 2014, 667,424 patients who underwent PCI were included in the program, with a mean age of 64.6 ± 12.3 years; most (86.5%) were white (Table 1). Prior coronary events, including prior myocardial infarction (MI) (30.4%), prior PCI (41.2%), and prior coronary artery bypass graft (CABG) (17.8%) were relatively common (Table 2). Approximately one-third of procedures were for elective indications. The number of participating hospitals was 1,612, the majority of which (87%) were private or community hospitals in urban or suburban locations (81%) (Table 3). The geographic distribution of participating centers is shown in Figure 1; CathPCI is used at 11 sites outside of the United States and U.S. territories.
The median time to primary PCI for patients with ST-segment elevation myocardial infarction (STEMI) was stable between 2011 and 2014 (Figure 2). Among patients who were not transferred for the procedure, the median time to primary PCI in 2014 was 59 min (10th, 50th, and 90th percentiles of 70, 60, and 48 min, respectively), which is below the guideline-recommended threshold of 90 min; the corresponding proportion of patients receiving PCI within this threshold was 93.5% (Figure 3). Among patients transferred for treatment, the median time to primary PCI was 105 min (10th, 50th, and 90th percentiles of 161, 108, and 80 min, respectively); 32.3% of transferred patients were treated within 90 min of presentation (Figure 3). In 2014, 93.5% of patients undergoing PCI received aspirin, P2Y12 inhibitors, and statins, provided they met eligibility for treatment at hospital discharge, compared with 89.1% in 2011 (Figure 4).
The CathPCI program also collects information regarding patient selection and technical aspects of procedures. Patient selection in CathPCI is assessed with the application of appropriate use criteria (Table 4) (27). In 2014, nearly all of the 563,448 PCIs performed for acute coronary syndromes that could be classified were appropriate indications (98.3%). Among patients without acute coronary syndromes, 53.5% of PCIs were performed for appropriate indications, 32.6% were classified as “may be appropriate,” and 13.9% as “rarely appropriate.” In 2014, 25.2% of cases/procedures were performed using a radial approach, compared with 10.9% in 2011 (Figure 5). A total of 2.4% of PCI cases in 2014 involved the use of mechanical ventricular support during the hospitalization, most of which (1.7%) was provided by intra-aortic balloon pump (IABP) (Figure 6). Mechanical support with an IABP was initiated before the PCI in 36.7% of cases (Figure 7); other forms of support (e.g., Impella [Abiomed, Danvers, Massachusetts] or other percutaneous LV assist device) were more commonly initiated before PCI (77.6%).
Procedure-related complications are also reported in CathPCI (Figure 8). Between 2011 and 2014, unadjusted rates of acute kidney injury were 2.3% and 2.6%, respectively; rates of blood transfusion were 1.9% and 1.4%, respectively. In 2014, post-procedural stroke occurred in 0.2% of procedures, emergency CABG surgery was performed after 0.2% of procedures, and vascular access site injury occurred in 1.3% of procedures.
NCDR ICD program
In January 2005, the Centers for Medicaid & Medicare Services (CMS) expanded coverage of ICDs on the basis of results of 3 major published randomized controlled trials (28). Concurrently, CMS mandated a national database for Medicare patients receiving ICDs for primary prevention. In response, the NCDR developed the ICD Program to assess the characteristics, care, and outcomes of patients undergoing ICD placement at participating centers, to determine if the findings from randomized controlled trials of ICDs are applicable to the general population, and to provide additional insights on outcomes after ICD implantation in subpopulations of particular interest (29). From its inception in 2006 to the end of 2014, ICD included data on over 1.3 million records. The program is used in all hospitals implanting devices if they provide primary prevention therapy to patients insured by Medicare, given the coverage with evidence decision. Eligible patients include all adults and pediatric patients undergoing ICD implantation, including device and lead replacements. CMS mandates that all Medicare beneficiaries receiving an ICD for primary prevention are reported in the program; 90% of all sites also choose to submit data on other patient populations, including those receiving a device for secondary prevention or those insured by other payers.
In 2014, 158,649 patient records were included in the program, the majority of which (81,406 or 51%) were patients with Medicare insurance coverage receiving a device for a primary prevention indication (Table 5). The mean age of the population was 67.1 ± 13.2 years, and 17.2% were at least 80 years of age; the majority (82.9%) were white. Most patients (83.4%) had heart failure documented before device implantation, and evidence of coronary disease was common (48.2% with prior MI, 32.9% with prior PCI, and 28.8% with prior CABG) (Table 6). The number of participating hospitals was 1,715, the majority of which (90%) were private or community hospitals in urban or suburban locations (79%) (Table 7). The geographic distribution of participating centers is shown in Figure 9; NCDR ICD is used by 3 sites outside of the United States and U.S. territories.
Although the majority of patients included in the NCDR ICD received a device for primary prevention, the program also included data on 38,421 patients receiving a device for a secondary prevention indication in 2014. The number of devices registered in NCDR ICD increased annually since 2011, when slightly more than 141,000 implantations were included, primarily attributable to an increase in initial generator implants (Figure 10). The proportion of secondary prevention devices in 2014 was 24.2%.
In 2014, of devices implanted for any indication, 25.0% were single-lead, 32.0% were dual-lead, and 42.7% were biventricular devices (Figure 11). Since 2011, there was an increase in the proportion of single-lead devices (from 19.4%) and a decrease in dual-lead devices (from 37.0%) and biventricular devices (43.5%). Patient selection in NCDR ICD is assessed with the application of ACC/AHA guideline criteria. The proportion of devices meeting Class I, IIa, and IIb indications was 88.2% in 2014, compared with 86.2% in 2011 (Figure 12).
The prescription of evidence-based medications for patients with prior MI and left ventricular systolic dysfunction (LVSD) in 2014 ranged from 83.9% for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for LVSD (compared with 81.2% in 2012) to 94.1% for beta-blockers for LVSD (compared with 92.4% in 2012) (Figure 13). Performance with respect to a composite medication measure for all these therapies among eligible patients, however, was only 80.3% in 2014, identifying an important target for improvement. Rates of in-hospital death in 2014 were 1.3%, compared with 1.4% in 2011 (Figure 14).
NCDR ACTION–GWTG program
ACTION-GWTG is sponsored jointly by the ACCF and the AHA, in partnership with the Society of Cardiovascular Patient Care and The American College of Emergency Physicians (30). ACTION–GWTG assesses the characteristics, treatments, and outcomes of patients with acute myocardial infarction (AMI) (both STEMI and non–ST-segment elevation myocardial infarction [NSTEMI]). From its inception in 2008 to the end of 2014, ACTION–GWTG included data on over 800,000 records. 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 first hospital presentation. Patients admitted for other conditions who subsequently develop AMI during hospitalization are not included.
In 2014, of 182,903 patients included in the ACTION–GWTG program, 71,368 (39.0%) had STEMI and 111,535 (61.0%) had NSTEMI. The mean age was 64.6 ± 13.6 years, 34.4% were women, and the majority (84.3%) were white (Table 8). Diabetes mellitus was present in 34.8%, a history of heart failure in 12.8%, and stroke in 7.7% (Table 9). Approximately one-quarter (24.8%) had a history of prior MI, 25.7% had a prior PCI, and 13.2% had previously undergone bypass surgery. The number of participating hospitals in 2014 was 907, which is estimated to represent 27% of acute care hospitals providing care for AMI. The majority of hospitals (89%) were private or community hospitals in urban or suburban locations (82%) (Table 10). The geographic distribution of participating centers is shown in Figure 15; ACTION–GWTG is used in 9 sites outside of the United States and U.S. territories. Almost all patients with STEMI (95.8%) undergo coronary angiography during hospitalization; the proportion of patients with NSTEMI undergoing angiography was 81.9% (Figure 16).
ACTION–GWTG reports a wide range of evidence-based quality measures and metrics pertinent to the care of AMI. With respect to the performance measures, institutional-level performance is reported in Table 11. Although the performance of centers in the 90th percentile is uniformly excellent, rates of performance in the 10th percentile identify important opportunities for improvement, such as the evaluation of LV ejection fraction during hospitalization (performed 88% of the time in centers in the 10th percentile), prescription of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge among patients with MI and LVSD (71.6% in centers in the 10th percentile), and referral to cardiac rehabilitation (11.1% in centers in the 10th percentile). Temporal trends in reperfusion times and the proportions of patients receiving reperfusion within 90 min between 2011 and 2014 are shown in Figures 17 and 18, respectively. Not all ACTION–GWTG participants have PCI capability, and in some cases, treat patients with fibrinolysis; the proportion of patients receiving fibrinolytic therapy with a door-to-needle time within the 30 min recommended by guidelines ranged from 46.8% in 2011 to 54.0% in 2014 (Figure 18).
The ACTION–GWTG program also reports composite metrics that permit more comprehensive assessments of the care provided for patients with AMI (Table 12) (see the Online Appendix for definitions of composites). To further guide quality improvement, the program provides centers with data on performance for a wider range of quality metrics (Table 13). The program also permits insights into the safety of care. Errors in dosing of anticoagulant and antiplatelet agents, particularly unfractionated heparin, are relatively common and represent an important target for protocols (Figure 19).
The ACTION–GWTG program also collects data on in-hospital outcomes, including death, reinfarction, heart failure, cardiogenic shock, stroke, and bleeding events (Figure 20). With the exception of stroke, these outcomes occur more commonly in patients with STEMI compared with those presenting with NSTEMI. Temporal trends in the risks of the more common in-hospital events of death, heart failure, and major bleeding between 2011 and 2014 are shown in Figure 21 for STEMI and Figure 22 for NSTEMI.
NCDR IMPACT program
The IMPACT program is sponsored by the ACCF. IMPACT was designed to assess the prevalence, demographics, management, and outcomes of pediatric patients (<18 years of age) and adult patients (≥18 years of age) with congenital heart disease (CHD) who undergo diagnostic catheterization-based interventions. From its inception in 2010 to the end of 2014, IMPACT included data on over 54,600 records. Its data support the development of evidence-based guidelines for CHD treatment that will improve outcomes for patients of all ages.
In 2014, IMPACT collected data on procedures for 20,169 patients. Almost one-half (46.4%) were female, and 86% were younger than 18 years of age; 71.2% were white (Table 14). Serious coexisting conditions were generally uncommon; 19.6% of patients had single-ventricle physiology (Table 15). IMPACT was used in 76 hospitals, which is estimated to represent 57% of hospitals that provide interventional services for patients with CHD. One-half of these hospitals (51%) were community centers; almost all (93%) were urban or suburban (Table 16). The geographic distribution of participating centers in 2014 is shown in Figure 23; IMPACT was used in 7 sites outside of the United States and U.S. territories.
Success rates for selected procedures are shown in Figure 24. Closures of atrial septal defects and patent ductus arteriosus exceeded 94%; rates of success for pulmonary valvuloplasty (84.3%), aortic coarctation stenting (87.4%), and aortic coarctation balloon angioplasty (55.1%) were lower. With respect to adverse procedural events, device embolization during atrial septal defect (1.2%) and patent ductus arteriosus (1.1%) occurred rarely; increases in aortic regurgitation after balloon valvuloplasty were 10.6% (Figure 25). Trends in major adverse events or death during the episode of care following diagnostic catheterization for CHD as a function of age are shown in Figure 26; adverse events were more common in younger age groups. Because these data include all events during hospitalization, these events are not necessarily directly attributable to the procedure per se.
The mission of the NCDR is to improve the quality of cardiovascular patient care by providing information, knowledge and tools; implementing quality initiatives; and supporting research that improves patient care and outcomes. As this report demonstrates, NCDR programs provide unique opportunities to advance the understanding of the clinical characteristics, care, and outcomes of patients with cardiovascular disease in the United States and, more recently, internationally. These programs collect data in geographically and structurally diverse care settings, and characterize the patients with high-impact cardiovascular conditions and undergoing common cardiovascular procedures, the clinical care they receive, and their outcomes.
The data in this report provide unique perspectives into the care and outcomes of cardiovascular diseases in the United States that are not available elsewhere. NCDR programs, through the contributions of the participating hospitals and practices, generate the benchmarks for local, regional, and national quality improvement and support health services research that informs practice and health policy. This report illustrates the strength of national quality programs using standardized data to advance the effectiveness and safety of patients with cardiovascular disease nationwide.
The authors wish to thank Jim Beachy, RCIS; Christina Koutras, BSN, RN, CPHQ; Beth Pruski, MSN, RN, CPHQ; Traci Connolly, RN, MS; and Cornelia Anderson, BSN, RN, CPHQ, for assistance in compiling the data for this report.
For definitions of performance measures and quality metrics, please see the online version of this article.
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 the 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.
- Abbreviations and Acronyms
- coronary artery bypass graft
- implantable cardioverter-defibrillator
- non–ST-segment elevation myocardial infarction
- percutaneous coronary intervention
- ST-segment elevation myocardial infarction
- Received July 18, 2016.
- Revision received December 8, 2016.
- Accepted December 16, 2016.
- 2017 American College of Cardiology Foundation
- Moussa I.,
- Hermann A.,
- Messenger J.C.,
- et al.
- ↵American College of Cardiology. NCDR Hospital Registries. Available at: http://cvquality.acc.org/NCDR-Home/Registries/Hospital-Registries.aspx. Accessed January 16, 2017.
- ↵American College of Cardiology. NCDR Outpatient Registries. Available at: http://cvquality.acc.org/NCDR-Home/Registries/Outpatient-Registries.aspx. Accessed January 16, 2017.
- Masoudi F.A.,
- Ponirakis A.,
- Yeh R.W.,
- et al.
- Holmes D.R. Jr..,
- Nishimura R.A.,
- Grover F.L.,
- et al.,
- for the STS/ACC TVT Registry
- Messenger J.C.,
- Ho K.K.,
- Young C.H.,
- et al.,
- for the NCDR Science and Quality Oversight Committee Data Quality Workgroup
- Bonow R.O.,
- Masoudi F.A.,
- Rumsfeld J.S.,
- et al.
- ↵Massachusetts Data Analysis Center, Department of Health Care Policy. Adult percutaneous coronary intervention in the Commonwealth of Massachusetts, Fiscal Year 2013 report (October 1, 2012 through September 30, 2013): hospital risk-standardized in-hospital mortality rates. Available at: http://www.massdac.org/wp-content/uploads/PCI-FY2013.pdf. Accessed January 16, 2017.
- ↵Blue Cross Blue Shield Blue Care Network of Michigan. Data collected through NCDR and BMC2 platforms. 2017. Available at: https://bmc2.org/pci-data-collection. Accessed January 16, 2017.
- Dehmer G.J.,
- Jennings J.,
- Madden R.A.,
- et al.
- Dehmer G.J.,
- Drozda J.P. Jr..,
- Brindis R.G.,
- et al.
- ↵American College of Cardiology. CardioSmart: Find Your Heart a Home. 2016. Available at: https://www.cardiosmart.org/Heart-Basics/Find-Your-Heart-a-Home. Accessed January 16, 2017.
- ↵Harder B, Comorow A. Methodology change will credit hospitals for transparency, reduce reputation. U.S. News & World Report Second Opinion. March 4, 2016. Available at: http://health.usnews.com/health-news/blogs/second-opinion/articles/2016-03-04/methodology-change-will-credit-hospitals-for-transparency-reduce-reputation. Accessed January 16, 2017.
- ↵Olmstead MG, Geisen E, Murphy J, et al. Methodology. U.S. News & World Report Best Children’s Hospitals 2014–15. U.S. News & World Report. 2014. Available at: http://www.usnews.com/pubfiles/2014_BCH_methodology_report.pdf. Accessed January 16, 2017.
- Lewis M.J.,
- Kennedy K.F.,
- Ginns J.,
- et al.
- Friedman D.J.,
- Singh J.P.,
- Curtis J.P.,
- et al.
- Brilakis E.S.,
- Banerjee S.,
- Karmpaliotis D.,
- et al.
- Peterson E.D.,
- Dai D.,
- DeLong E.R.,
- et al.,
- for the NCDR Registry Participants
- Rao S.V.,
- McCoy L.A.,
- Spertus J.A.,
- et al.
- Tsai T.T.,
- Patel U.D.,
- Chang T.I.,
- et al.
- Strauss C.E.,
- Porten B.R.,
- Chavez I.J.,
- et al.
- Sherwood M.W.,
- Brennan J.,
- Ho K.K.,
- et al.
- Borden W.B.,
- Maddox T.M.,
- Tang F.,
- et al.
- Shah R.U.,
- de Lemos J.A.,
- Wang T.Y.,
- et al.
- Patel M.R.,
- Dehmer G.J.,
- Hirshfeld J.W.,
- et al.
- Peterson E.D.,
- Roe M.T.,
- Chen A.Y.,
- et al.