Studies Use PINNACLE Registry Data For Closer Looks at NOACs and Statins

Oetgen,WilliamThis post was authored by William J. Oetgen, MD, MBA, FACC, executive vice president of ACC’s Publication, Education, Science and Quality.

New research on the use of novel oral anticoagulants for atrial fibrillation (AFib) patients and statins for diabetes patients from the NCDR’s outpatient PINNACLE Registry will be presented during the American Heart Association’s (AHA’s) meeting in Orlando.

Three abstracts will look at gender differences in use of anticoagulants for AFib (Sunday, Nov. 8 at 4:45 p.m. ET); frequency and practice level variation in statin use among diabetes patients (Monday, Nov. 9 at 9:00 a.m. ET); and impacts of introducing novel oral anticoagulants to overall oral anticoagulation rates in AFib (Monday, Nov. 9 at 6:00 p.m. ET). (Check out the ACC’s complete coverage of these and other studies at Continue reading

PINNACLE Registry QI Program in India: A Model For Other Resource-Limited Countries?

This post was authored by Nathan Glusenkamp, MA, director of the PINNACLE Program and William J. Oetgen, MD, MBA, FACC, executive vice president of the ACC’s Publication, Education, Science & Quality.

Today marks a seminal event in the evolution of the PINNACLE Registry with the publication of an article in the Journal of the American Heart Association. “Cardiovascular Disease Performance Measures in the Outpatient Setting in India: Insights from the American College of Cardiology’s PINNACLE India Quality Improvement Program (PIQIP)” is the first published report from PIQIP, an international project within the PINNACLE Registry program that has been ongoing for the past three years. Continue reading

PINNACLE Registry Wraps Up Successful Year of Research

This post was authored by William J. Oetgen, MD, MBA, FACC, executive vice president of Science, Education, & Quality of the ACC.

I recently had the opportunity, along with other members of the ACC staff, to serve on the research team for a project that analyzed data from the PINNACLE Registry India database. The database now includes well over 100,000 patient records collected from Indian hospital outpatient clinics. Using this database, Yashashwi  Pokharel, MD, MSCR, and a team of his colleagues recently submitted an abstract entitled “Guideline Recommended Medication Use Among Systolic Heart Failure (HF) Patients in India: Insights from the American College of Cardiology Practice Innovation and Clinical Excellence (PINNACLE) India Registry,” to the 66th Annual Conference of the Cardiological Society of India. The abstract was selected for a prestigious oral presentation at the conference this past December, which was delivered by Prafulla Kerkar, MD, FACC, the Mumbai-based chair of the PINNACLE India research group. Not only does this study inform us on guideline-recommended medication use among patients in India, but it also marks the first time data from ACC’s outpatient registry in India have been presented at a conference outside of the U.S. Continue reading

Roundtable Continues Important Discussions Around Anticoagulation Therapy

This post was authored by Kim Williams, Sr., MD, FACC, president-elect of the ACC.

Over the years the use of anticoagulants have become a vital means of treating atrial fibrillation, atrial flutter, acute coronary syndromes, ischemic stroke, pulmonary embolism and venous thrombosis. Managing the layered facets of their use, however, can at times be quite daunting for the patients, physicians, nurses, pharmacists and any other stakeholders involved.

In an effort to continue much needed discussions about anticoagulation therapy, including key questions facing providers, patient barriers and evolving research and treatment options, the ACC brought together a number of stakeholders across the health care spectrum for its 2nd Anticoagulation Consortium Roundtable on Saturday, Sept. 27. Continue reading

The CardioMetabolic Health Alliance: Improving Quality, Bending the Cost Curve

This post is authored by Gary Puckrein, PhD, president and chief executive officer of the National Minority Quality Forum.

Physicians and the medical community have reached a fork in the road: we need to document that quality and reduced costs are related. By doing so, we hope to offer policymakers a new framework in which to measure the value of medicine. The conjectures:

  • An avoidable mortality index can be an indicator of unnecessary acute events (disease, hospitalizations, disability and death) in a population. Such an index may have utility in localizing the performance of our health care system, thus enabling the investigation of gaps in outcomes of care.
  • There are signals that avoidable acute events are non-random occurrences. There is a possibility that they manifest at predictable frequencies within clinical and geographic sub-populations, and are sentinels of health care and health status disparities.
  • Unnecessary acute events have financial implications. At least one study found that 36% of diabetes-related hospitalizations were avoidable. If that percentage holds true for Medicare beneficiaries, the savings could well be over $10 billion per year.
  • By reducing unnecessary acute events, we may be able to establish an association between improved quality and bending the cost curve, thereby offering a counterpoint to those who believe reducing provider reimbursements is a desirable cost savings device.

The American College of Cardiology, the National Minority Quality Forum (NMQF), and the American Association of Clinical Endocrinologists have joined forces to put our conjectures to the test and have formed the CardioMetabolic Health Alliance. The objective of the Alliance is to improve cardiometabolic risk factor control in diverse populations, including high blood pressure, elevated fasting blood sugar, dyslipidemia, abdominal obesity (waist circumference) and elevated triglycerides; and to provide more effective and coordinated care for people with established cardiometabolic disorders.

In pursuit of its mission, the Alliance will study the possibility that predictable patterns of unnecessary acute cardiac events occur in communities, and that these patterns are measurable and amenable within the context of current treatment modalities. By using the ACC’s PINNACLE Registry and CathPCI Registry, as well as NMQF’s Cardiovascular Disease Index and U.S. Diabetes Index, the Alliance will explore the possible correlation between cardiometabolic disease and unnecessary emergency room visits and hospitalizations; and how these findings can be used to design predictive models and quality improvement interventions targeted for providers and patients at high risk for an acute cardiovascular episode.

Members of the CardioMetabolic Health Alliance and ACC will be meeting at the 2012 Cardiometabolic Health Congress this week in Boston, Ma. Visit the Alliance’s website for more information Also read more about CardioMetabolic Syndrome in an article in the July/August issue of Cardiology magazine.

Keeping Relevant in a Changing Field – the Expansion of the PINNACLE Registry

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.

Tools and Initiatives to Incorporate Best Practices in Day-to-Day Care

This post is authored by Richard Kovacs, MD, FACC, chair of the Best Practices and Quality Improvement Subcommittee, a subcommittee of the College’s Clinical Quality Committee.

The ACC is leveraging AFib Awareness month to highlight the many ways the College has stayed on top of the clinical and practice needs and demands of CV professionals in what is truly an evolving landscape.

This month the ACC launched an Atrial Fibrillation (AFib) Toolkit to provide tools and strategies for the patient care team to support high-quality care for patients with AFib.  Rather than only defining high-quality AFib care as defined by clinical performance on National Quality Forum endorsed measures, the AFib Toolkit establishes clear goals for overall high-quality AFib care by identifying and filling gaps in the knowledge and behavior of the patient and the patient care team in meeting these goals.

Included in the AFib Toolkit:

  • Five tools focused on diagnosis and risk assessment
  • Four tools, plus 23 individual drug monographs, for treatment and management of AFib
  • Three tools focused on patient education

As noted in last week’s blog post, AFib is the most common arrhythmia in clinical practice, and is responsible for 15-20 percent of all strokes, which account for 1 in 17 deaths in the U.S. and rank third among all causes of death after heart disease and cancer. In addition to improving clinician adherence to National Quality Forum endorsed performance measures for AFib, the AFib Toolkit will increase patient awareness of the risks associated with AFib, and enhance patient engagement in their AFib care plan.  Provider understanding and inclusion of patient behavior, choices, and lifestyles in care planning is especially important with AFib because of the rapidly evolving landscape of AFib therapies.  The AFib Toolkit is an opportunity to identify approaches for supporting the patient-provider partnership in meeting care goals among considerable safety and efficacy concerns.

In addition to the AFib toolkit, the ACC provides innovative educational programs like A New ERA v 2.0, a free Performance Improvement-Continuing Medical Education activity designed to help physicians improve the care of their patients with atrial fibrillation. To track data of patients with AFib, last year the PINNACLE Registry launched a new platform, PINNACLE-AF, focusing on atrial fibrillation and including the next generation of anticoagulants. Currently a new national anticoagulation initiative, led by ACC, is under development to drive awareness of the efficacy and safety of new anticoagulation therapies.

In the end, whether we’re talking about AFib, or another area identified as ripe for improvement, ACC members need real-time, easy-to-use solutions that cross the spectrum of quality, advocacy and education and bring about real change. The efforts underway by a multi-disciplinary team of ACC members and staff are bringing these tools to life.

This blog post is part of a series of blog posts during AFib Awareness Month. Stay tuned in the coming weeks for more information from the College on AFib news, tools and initiatives. Also visit ACC’s Facebook page for additional information.

Simple Steps to Manage a Growing Health Problem

Hypertension, or high blood pressure, is a major and growing public health problem in the United States.  Approximately 72 million people in the U.S., or about 1 in 3 adults suffer from the disease, which if left untreated can increase risks for heart attack, stroke, and/or other health complications. Blood pressure management has been identified as a key component of the Million Hearts initiative, led by CMS and CDC with a goal to prevent one million heart attacks and strokes over the next five years by focusing on the “ABCS” (aspirin for high-risk patients, blood-pressure control, cholesterol management, and smoking cessation).

As part of “National High Blood Pressure Education Month,” the ACC throughout May is focused on reminding cardiovascular professionals about the tools and resources available to help not only improve care for patients with/or at risk of  hypertension, but also help educate patients about the importance of controlling their blood pressure and minimizing their cardiovascular risks.

Just last year, the ACC Foundation, along with the American Heart Association and the American Medical Association – Physician Consortium for Performance Improvement, released truly ground-breaking performance measures designed to help clinicians treating adults with coronary artery disease (CAD) and hypertension (view the Performance Measures here). Unlike previous measures, these focused not just on treatment in the hospital setting, but on primary and secondary prevention as well. They also addressed whether important cardiac risk factors are being “controlled” to targeted goals vs. simply “treated” – a move that requires much greater patient involvement in treatment and care decisions. Finally, these performance measures emphasized patient-focused functional outcomes and stressed the need to not only assess patient angina and functional symptoms but also to develop treatment plans to improve these outcomes.

The ACC’s PINNACLE Registry takes these performance measures and puts them into action. Registry participants collect data on practice performance and then receive quarterly benchmark reports that can and should be used to identify areas for improvement. Participants in the registry also have access to the PINNACLE Network as a means of sharing best practices and encouraging quality improvement among registry users. PINNACLE is one of the primary ways the ACC is working on a national level with the Million Heart’s initiative.

The ACC’s CardioSmartTM initiative is also a critical resource when it comes to hypertension. Cardiac care providers can download patient fact sheets in both English and Spanish, or send patients directly to to take advantage of the CardioSmart Health Tracker: Blood Pressure Tool. CardioSmart has set a goal of capturing 5,000 blood pressures through the month of May via the online tool and working with its partners at the grassroots level.

Sometimes the toughest problems have the easiest solutions. When it comes to taking down the number one cause of mortality worldwide, taking simple steps to manage conditions like blood pressure can go a long way.

In case you missed it, there’s only one day left to participate in the Office of the National Coordinator for Health Information Technology (ONC), Million Hearts and AHA “Beat Down Blood Pressure” video challenge:

How are you helping your patients manage hypertension? Share your tips in the comment section below!

ACC on the Hill

Last week I had the pleasure of testifying on behalf of the ACC at the House Ways and Means Subcommittee on Health during a special hearing to explore how private sector payers are rewarding physicians who deliver high quality and efficient care. I was joined by other panelists: Lewis G. Sandy, MD, senior vice president, Clinical Advancement, UnitedHealth Group; David Share, MD, MPH, vice president, Value Partnerships, Blue Cross Blue Shield Michigan; John L. Bender, MD president and CEO, Miramont Family Medicine; and Len Nichols, PhD, director, Center for Health Policy Research and Ethics and editor-in-chief of the ACC’s online Community on Payment Innovations.

During my testimony I discussed several of the quality improvement collaborations underway in cardiology and what lessons can be applied across the health care system to simultaneously reduce unnecessary readmissions, complications, testing, and ineffective spending. My testimony also focused on the power of data as exemplified by our experience with the NCDR and the importance of decision support tools in helping care providers actually use evidence-based guidelines and appropriate use criteria to “get science to the point of care” to ensure not only the right therapy and/or test, but also engage patients in the decision making process. I also focused on the ways the ACC is currently working to “put the data to work” through programs like Hospital to Home, Imaging in FOCUS and PINNACLE. I also expressed the need for payment reforms linked to these tools.

A big part of my testimony was also the “SMARTCare” projects currently underway in Wisconsin and Florida that combine data collection, decision support and quality improvement initiatives into a focused project that documents clinical quality, resource use and cost variation in the treatment of stable ischemic heart disease. The projects are driven by the ACC’s state chapters and the ACC in collaboration with integrated health care systems, payers and multi-stakeholder collaborative groups.

The ACC was absolutely a vital part of this conversation. The development of innovative new programs and payment models that reward physicians who deliver high quality and efficient care has been a College priority over the last several years in light of health care reform and the need to curb out-of-control health care costs. I also told the Subcommittee that one of the key points to keep in mind about new systems is the time it takes to implement — so the faster they are established the faster we can move forward with implementing these new payment reforms!

I invite you to share your “big ideas” on how to reward providers for quality care and cost savings in the comment section below.

Read the complete testimony and learn more about the hearing here.