By William J. Oetgen, MD, MBA, FACC, senior vice president of Science and Quality of the ACC.
The ACC’s NCDR® is comprised of six hospital-based registries and one ambulatory registry, known as the PINNACLE Registry®. These registries measure the application of clinical guidelines in the real world setting – which helps us target national opportunities for quality improvement.
The PINNACLE Registry currently has 5.3 million patient encounter records covering 1.5 million unique patients, submitted from over 550 office locations nationwide. Of those patients, nearly 320,000 have atrial fibrillation (AFib), which is the most common arrhythmia in clinical practice, and is responsible for 15-20 percent of all strokes. Due to the growing need for the understanding of treatments and practice patterns for AFib, last year we announced the expansion of the PINNACLE Registry to include a new platform focusing on AFib, and include the next generation of anticoagulants coming online.
As new treatments are introduced to the market, assessing shifts in care patterns – and the impact of these shifts on patients – is a top clinical and research priority. The Registry can provide a means to monitor practice pattern changes over time while we rigorously assess current practice patterns and provide feedback reports to help providers evaluate and improve adherence to established guidelines and performance measures. We are also interested to see if these new medications coming online change the way doctors think about stroke prevention, which will ultimately help us close a long-standing quality gap in anticoagulation.
PINNACLE-AF is already yielding powerful clinical insights, and a study published last year in the American Journal of Cardiology used the PINNACLE Registry to look at treatment rates with warfarin in outpatients with nonvalvular AFib who were at moderate to high risk for stroke, as well as the extent of patient- and practice- level variation in warfarin use. The investigators found that warfarin treatment in AFib was suboptimal, with large variations in treatment observed across practice, and noted that their findings suggest important opportunities for practice-level improvement in stroke prevention for outpatients with AFib and define a benchmark treatment rate before the introduction of newer anticoagulant agents.
Because global anticoagulation patterns, especially in emerging markets, are less understood, the ACC recently conducted a transnational survey of AFib patterns the U.S., U.K., Germany, Brazil, India, and China, in order to develop a broader understanding of the causes of gaps in anticoagulation. The October issue of CardioSource WorldNews details the results, so be on the lookout for your copy hitting newsstands in the coming weeks. As mentioned in a previous blog post, the College is currently in the early stages of developing a comprehensive initiative to address gaps in treatment and encourage compliance with guideline-recommended care.
The power of registries is immense, and we encourage the use of this quality improvement tool – all in the name of improving quality and outcomes for patients. Expect to see more data and research come to fruition in the coming months, especially in the topics related to kidney function and bleeding risk and events which are areas of clinical import with the next generation of anticoagulants.