Trends in Cardiovascular Care: Data from the NCDR® Registries
In an effort to improve care quality for patients receiving cardiovascular-related therapies and procedures, the American College of Cardiology (ACC) developed the National Cardiovascular Data Registries (NCDR®) in 1998. The NCDR® measures compliance to performance metrics and aims to provide evidence-based performance feedback for centers wishing to discover opportunities for improving their quality of care.
A report published in the Journal of American College of Cardiology sought to evaluate the NCDR® to determine the current outlook of cardiovascular care in the United States, especially as it relates to percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).1
The NCDR® registries analyzed in this review include:
- Implantable Cardioverter Defibrillator (ICD)®
- Acute Coronary Treatment and Intervention Outcomes Network
- (ACTION)®–Get with the Guidelines (GWTG)™
- Improving Pediatric and Adult Congenital Treatment (IMPACT)®
Currently, over 2000 hospitals and healthcare facilities participate in the NCDR® reporting process and are used as an accurate representation of patient care across the nation.
This registry examines the characteristics and outcomes of patients who have received a cardiovascular procedure, like PCI or CABG, in a Cath lab. Included in this program were 667,424 patients who received PCI in 2014, many of whom had a coronary event prior to the procedure. Median time to primary PCI in non-transferred patients was around 59 minutes. Only 32.3% of patients who were transferred received PCI within a 90-minute window of presentation.
Around 98.3% of patients with an acute coronary syndrome (ACS) had the appropriate indications for PCI. In 2014, mechanical ventricular support was used for 2.4% of PCI cases (Figure 1), 1.7% of which was attributed to the intra-aortic balloon pump (IABP). The Impella was initiated prior to PCI in 77.6% of cases, whereas IABP was used in 36.7% of cases.
Unadjusted rates of postprocedural stroke, acute kidney injury, and vascular access site injury was 0.2%, 2.6%, and 1.3%, respectively.
Sponsored by both the ACCF and the American Heart Association, this program examines the treatment outcomes of acute myocardial infarction (AMI) patients with both ST segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). The majority of patients included in the 2014 registry analysis had NSTEMI (61.0%) vs STEMI (39.0%). In regard to patient characteristics, many had a present diagnosis of diabetes mellitus (34.8%), and a smaller subset had a history of MI (24.8%), stroke (7.7%), and heart failure (12.8%). Rates of cardiogenic shock, death, heart failure, and reinfarction occurred more frequently in patients with STEMI than NSTEMI, according to the available data on in-hospital events.
Participation in and routine evaluation of the NCDR® programs plays a pivotal role in the evolution of cardiovascular care. Subsequently, any knowledge and/or advancement garnered from these data may translate into improved outcomes for patients undergoing interventional cardiovascular procedures. Additional involvement in the program may enable improved comprehension of cardiovascular disease and its treatment. Thus, hospitals and care centers are encouraged to participate in these programs to ensure further understanding of common cardiovascular therapies as well as the relationship between therapies and patient characteristics, geographic data, and level of care.
- Masoudi FA, Ponirakis A, de Lemos JA, et al. Trends in U.S. Cardiovascular Care: 2016 Report from 4 ACC National Cardiovascular Data Registries. J Am Coll Cardiol. 2016.
To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: abiomed.com/important-safety-information