Insights into the patient populations,
participating centers and patterns of care based on 2014 data from four of
the 10 NCDR programs - CathPCI Registry, ICD Registry, ACTION
Registry-GWTG and IMPACT Registry has been provided by the report "Trends in Cardiovascular Care in the United States: a
Report from Four American College of Cardiology National Cardiovascular
Data Registry Programs".
Over 93% of heart attack patients are receiving stents within
the guideline-recommended threshold of 90 minutes after arriving at the
hospital, with the median time to stenting only 59 minutes, suggested
a broad report on trends in heart disease care from the American
College of Cardiology's National Cardiovascular Data Registry published
in the Journal of the American College of Cardiology
‘The registry data provides unique perspectives into the care and outcomes of heart disease care in the United States and illustrates the strength of national quality programs.’
The authors of the report said the registry data provide unique
perspectives into the care and outcomes of heart disease care in the
U.S. and illustrate the strength of national quality programs, like
NCDR, in advancing the effectiveness and safety of treatments for heart
"We were able to report on the care and outcomes of patients
undergoing common cardiovascular procedures, including percutaneous
coronary interventions, implantable defibrillators, and interventions
for congenital heart disease as well as for patients with acute heart
attacks," NCDR Management Board Chair and lead author of the study
Frederick A. Masoudi said. "In some cases, hospitals
are consistently providing excellent care; the registries, however,
allow us to identify those aspects of care where the cardiovascular
clinical community can improve."
Key findings from each registry include:
- Of the 667,424 patients undergoing PCI in 2014, 35.3
percent of PCIs were performed for elective indications, compared to
64.7% performed for non-elective indications.
- Between 2011 and 2014, the use of femoral access
decline from 88.4% to 74.5%, while the use of radial
access increased from 10.9% to 25.2%.
- Use of evidence-based therapies, including aspirin,
P2Y12 inhibitors and statins for eligible patients, continue to remain
high at 93.3%.
- Median door-to-balloon time for primary PCI for STEMI
also remains strong at 59 minutes for patients receiving PCI at the
presenting hospital and 105 minutes for transfer patients.
- Of the 158,649 patients receiving ICD therapy in 2014,
120,228 received a device for primary prevention reasons, compared to
38,421 who received a device for secondary prevention indications.
- Of all ICD implants in 2014, 25% involved
single chamber devices, 32 percent involved dual chamber devices and 43% involved CRT-D devices, compared to 19%, 37% and
44 percent, respectively, in 2011.
- While use of evidence-based therapies are generally
high, performance on a composite medication metric, including use of ACE
or ARB for patients with LVSD and beta blockers for patients with LVSD,
could be a target for quality improvement efforts. Between 2011 and
2014 the composite rate of use grew from 76.7% to 80.3%,
with room for continued improvement.
- Of the 182,903 patients with acute myocardial
infarction (AMI) in 2014, 71,368 had ST-segment elevation MI (STEMI),
while 111,535 had non-ST-segment elevation acute coronary syndromes
- There is room for improvement in the areas of overall
defect-free care (78.4%); P2Y12 inhibitor use in eligible
patients (56.7%); and use of aldosterone antagonists in patients
with LV systolic dysfunction and either diabetes or heart failure (12.8%).
- Compared to NSTEMI patients, STEMI patients were more
likely to experience certain adverse events during hospitalization,
including death (6.4% vs. 3.4%); cardiogenic shock (4.4% vs. 1.6%), or bleeding (8.5% vs. 5.5%).
- Of the STEMI patients, 95.8% underwent coronary
angiography and 90.7% underwent PCI, compared to NSTEMI patients
of which 81.9% underwent coronary angiography and 52.4%
- Of the 20,169 patients with congenital heart disease
undergoing cardiac catheterization or a catheter-based intervention, 86% were under the age of 18 and 24.6% were under one year
- Procedures such as atrial septal defect (ASD) closure,
patent ductus arteriosus (PDA) closure, aortic coarctation stenting and
pulmonary valvulolasty had success rates exceeding 84%. Aortic
coarctation balloon angioplasty was less successful at 55.1%.
- Device embolization was reported in 1.2% of ASD
closure procedures and 1.1% of PDA closure procedures. A
clinically significant increase in aortic regurgitation follow
valvuloplasty was noted in 10.6% of cases.
In a corresponding executive summary also published in JACC, Masoudi
said "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."