ACTION Registry™ (Acute Coronary Treatment and Intervention Outcomes Network)

Initial Report1st Quarter 2007 Results

Report prepared by:

www. ncdr.com

Background

• Recent studies have demonstrated that guidelines adherence is sub-optimal for a large proportion of ACS patients.

• The ACTION Registry has been created to enable hospitals to measure and improve their performance in treating patients with ACS against national benchmarks.

• Contained in this report are performance information from the 2006-2007 harvest from CRUSADE and the ACTION Registry.

The ACTION Registry

• Represents the merger of two of the nation’s premier ACS registries: – NRMI (National Registry of Myocardial Infarction)– CRUSADE (Can Rapid Risk Stratification of Unstable

Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC and AHA Guidelines)

• Unified under the leadership and support of NCDR™ :– Guidelines, performance indictors, and data standard

alignment– Clinical/technical/contract support– Training and orientation www. ncdr.com

Goals of the ACTION Registry

• The nation’s ACS surveillance system– Assess characteristics, treatments, and outcomes of patients

hospitalized with STEMI and NSTEMI

• Optimize the care and outcomes of ACS patients– Implement ALL evidence-based guideline recommendations in

clinical practice– Assure that the right things are done right (safe and timely).

• Facilitate efforts to improve ACS care quality and safety via novel QI improvement methods

ACTION QI Tool Development

• Quarterly feedback reports • Individualized GAP analysis• On-line, real-time summaries• QI tool kits• D2B tool kits• Monthly Webcasts• Regional group meetings• Take ACTION™ Campaign

2006-07 Data Submission Summary

Admission # of # of # of Timeframe Sites NSTEMI Records STEMI Records

ACTION Jan. 1, 2007 – 227 6,917 4,259 Mar. 31, 2007

CRUSADE April 1, 2006 – 280 20,084 4,391 Dec. 31, 2006

ACTION Registry 2007 Patient Enrollment

4169

37874004

4241 4154

0

1000

2000

3000

4000

5000

Jan-07 Feb-07 Mar-07 Apr-07 May-07

Nu

mb

er o

f P

atie

nts

en

rolle

d

Complexity of NSTEMI PtsBaseline Characteristics

NSTEMIVariable (n = 26,902)

Mean age ± SD (yrs) 69 ± 14Female Diabetes mellitus Prior MI Prior CHF Prior PCI Prior CABG

ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902)ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902)

40%33%29%16%23%19%

Hospital Presentation

Variable NSTEMI (n = 26,902)

Qualifying criteria ST-segment depression Transient ST-segment elevation Presenting characteristics Tachycardia Hypotension Signs of CHF

ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902)ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902)

25%4%

22%3%22%

In-Hospital Outcomes

Variable NSTEMI (n = 26,902)

Death Re-infarction CHF Cardiogenic Shock Stroke RBC Transfusion*

*Excluding CABG patientsACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902)*Excluding CABG patientsACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902)

3.8%1.5%6.8%2.4%0.7%8.9%

NSTEMI Acute Medications

ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007

97%93%

85%

53%

60%

0%

20%

40%

60%

80%

100%

ASA BetaBlockers

Heparin(LMW+UHF)

GP llb-lllaInhibitors

Clopidogrel

NSTEMI Invasive Cardiac Procedures

89%

69%

54%

45%

12%

0%

20%

40%

60%

80%

100%

Cath Cath <48 hr PCI PCI <48 hr CABG

ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007

*LVEF < 40%, CHF, DM, HTN# Known hyperlipidemia, TC, LDL ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n= 26,902)

NSTEMI Discharge Medications96% 95%

73%

91%

74%

0%

20%

40%

60%

80%

100%

ASA B-Blocker ACE-I or ARB* Lipid LoweringAgent#

Clopidogrel

% U

se%

Use

NSTEMI Discharge Interventions

18%

86%

65%

92%

0%

20%

40%

60%

80%

100%

ExerciseCounseling

DietaryModification

CardiacRehab

Referral

SmokingCessation

ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007