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2007 ACTION Registry ™ 2nd Quarter Results. Background. Recent studies have demonstrated that guidelines adherence is sub-optimal for a large proportion of ACS patients. - PowerPoint PPT Presentation
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2007 ACTION Registry™ 2nd Quarter Results
Background
• Recent studies have demonstrated that guidelines adherence is sub-optimal for a large proportion of ACS patients.
• The ACTION Registry™ has been created from the previous CRUSADE and NRMI registries to enable hospitals to measure and improve their performance in treating patients with ACS
• Contained are performance information from the 2006-2007 harvest from both the CRUSADE and ACTION registries.
Current ACTION Site Distribution
Last updated: 1/4/07
AK(1)
WA(12)
OR(6)
CA(15)
ID(1)
NV(0)
MT(1)
WY(0)
CO(7)
NM(0)
ND(1)
SD(1)
NE (4)
KS(5)
OK(2)
TX(11)
MN(5)
IA(7)
MO(8)
AR(1)
LA(2)
WI(6) MI
(14)
MI
UT(0)
AZ(3)
HI (0)
IL(18)
IN(12)
KY(2)
TN(8)
MS(5)
AL(3)
GA(8)
FL(9)
SC(3)
NC(17)
VA(11)
OH(22)
WV(1)
PA(26)
NY(10)
MD (11)
ME(1)
VT (0)
NH (1)
NJ (6)
MA (1)
CT (2)
DE (0)
RI (0)
DC (0)
Active Sites = 290
ACTION 2007 Cumulative Data Submission
4169
7956
11960
16201
20355
24319
0
5000
10000
15000
20000
25000
Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07
Nu
mb
er o
f re
cord
s
Complexity of STEMI PatientsBaseline Characteristics
ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007
Variable STEMI
(n = 11,854) Mean age ± SD (yrs) 62 ± 12 Female sex 30% Diabetes mellitus 23% Prior MI 18% Prior CHF 5% Prior PCI 18% Prior CABG 7%
Hospital Presentation - STEMI
ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007
Variable STEMI
(n = 11,854) Qualifying Criteria Persistent ST Elevation 95% New LBBB 5% Presenting Characteristics Tachycardia 16% Hypotension 6% Signs of CHF 12%
In-Hospital Outcomes - STEMI
*Transfusion among non-CABG patientsACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007*Transfusion among non-CABG patientsACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007
Variable STEMI
(n=11,854) Death 6.0% Re-infarction 1.2% CHF 6.6% Cardiogenic Shock 7.1% Stroke 0.8% RBC Transfusion 6.2%
Use of Reperfusion Therapy for STEMI
STEMISTEMIN = 11,854N = 11,854
ReperfusionReperfusionN = 8,954 (76%)N = 8,954 (76%)
No Reperfusion –No Reperfusion –No Contraindication ListedNo Contraindication Listed
N = 690 (6%)N = 690 (6%)
Not Eligible for Not Eligible for Reperfusion Therapy Reperfusion Therapy Contraindication Listed Contraindication Listed
N= 1,926 (16%)N= 1,926 (16%)
Primary PCI – 81%*Primary PCI – 81%*Fibrinolytics – 10%*Fibrinolytics – 10%*
Both PCI + Lytics – 9%*Both PCI + Lytics – 9%*
90% of eligible patients reperfused
ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007
* Among patients receiving reperfusion
60%
5%
40%
0%
20%
40%
60%
80%
DTB <= 90 min -Non-Transfer In
DTB <= 90 min -Transfer In
DTN <= 30 min - All
DTB = 1st Door to Balloon for Primary PCIDTN = Door to Needle for Lytics
ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)
STEMI – Door to Balloon and Door to Needle Times:
Cumulative 12 Month Data
47% 50%
64% 64%
0%
20%
40%
60%
80%
100%
Q3 06 Q4 06 Q1 07 Q2 07
CRUSADE to ACTION Quarter Results -Non-Transfer Patients with DTB 90 mins
Non-transfer patients represent ~ 2/3 of primary PCI population
2%
6% 6% 5%
14%
21% 21% 21%
0%
10%
20%
30%
40%
Q3 06 Q4 06 Q1 07 Q2 07
CRUSADE to ACTION Quarter Results - DTB Benchmarks for Transfer-In Patients
Transfer In patients represent ~ 1/3 of primary PCI population
1st Door to Balloon < 90 Minutes
1st Door to Balloon < 120 Minutes
CRUSADE to ACTION Door-to-Balloon Times –
Median Times for Transfer In and Non-Transfer In Patients
Transfer in DTB Times Non-Transfer in DTB Times
130
176
231
67
90
119
Q3 06
122
148
211
67
87
119
Q4 06
123
170
236
6279
Q1 07
122
159
223
59
78
103
Q2 07
Tim
e (m
in)
50
220210
60708090
110100
120130140150160170
200
180190
240230
103
403020
250
100
STEMI Acute Medications
ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)
98% 96%93%
75%
84%
0%
20%
40%
60%
80%
100%
ASA BetaBlockers
Heparin(LMW+UFH)
GP llb-lllaInhibitors
Clopidogrel
*Ideal patients ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n= 11,854)
STEMI Discharge Medications
99% 97%
89% 91% 90%
0%
20%
40%
60%
80%
100%
ASA B-Blocker ACE-I or ARB* Statins Clopidogrel
% U
se%
Use
STEMI Discharge Interventions
81%
92%
77%
96%
0%
20%
40%
60%
80%
100%
ExerciseCounseling
DietaryModification
CardiacRehab
Referral
SmokingCessation
ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)ACTION/CRUSADE DATA: July 1, 2006 – June 30, 2007 (n=11,854)