JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
VOL. 69, NO. 11, 2017
ª 2017 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION
ISSN 0735-1097/$36.00
PUBLISHED BY ELSEVIER
http://dx.doi.org/10.1016/j.jacc.2016.12.004
THE PRESENT AND FUTURE
Executive Summary:
Trends in U.S. Cardiovascular Care
2016 Report From 4 ACC National Cardiovascular Data Registries
Frederick A. Masoudi, MD, MSPHa,b
William J. Oetgen, MD, MBAc
Angelo Ponirakis, PHDc
Paul D. Varosy, MDi
James A. de Lemos, MDd
Robert N. Vincent, MD, CMj
James G. Jollis, MDe
Jessica Wei, MD, MSc
Mark Kremers, MDf
Jeptha P. Curtis, MDk
John C. Messenger, MDa
Matthew T. Roe, MD, MHSl
John W.M. Moore, MD, MPHg
John A. Spertus, MD, MPHm
Issam Moussa, MDh
The National Cardiovascular Data Registry (NCDR) of
procedures.
the American College of Cardiology consists of 10
benchmarking of a broad range of quality metrics to
The
NCDR
national programs designed to measure quality of
participants,
care for high-impact cardiovascular conditions and
terventions at the local and national level, and serves
supports
provides
quality
feedback
improvement
with
in-
From the aDepartment of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado; bColorado Cardiovascular Outcomes Research
Consortium, Denver, Colorado; cAmerican College of Cardiology Foundation, Washington, DC; dDepartment of Medicine, University of Texas Southwestern, Dallas, Texas; eDepartment of Medicine, University of North Carolina, Chapel Hill, North Carolina; fNovant Health Heart and Vascular Institute,
Charlotte, North Carolina; gDivision of Cardiology, Department of Pediatrics, Rady Children’s Hospital, University of California–San Diego, San Diego,
California; hDivision of Cardiology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; iVA Eastern
Colorado Health Care System, University of Colorado, and Colorado Cardiovascular Outcomes Research Group, Denver, Colorado; jDivision of Cardiology, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia; kDepartment of Medicine, Yale University, New
Haven, Connecticut; lDuke Cardiovascular Research Institute, Durham, North Carolina; and the
m
Division of Cardiovascular Diseases, Mid-America
Heart Institute, Kansas City, Kansas. Dr. Masoudi has a contract with the American College of Cardiology Foundation for his role as Chief Science
Officer of the National Cardiovascular Data Registry. Dr. Ponirakis, Dr. Oetgen, and Ms. Wei are employed by the American College of Cardiology
Foundation. Dr. de Lemos has received grant support from Roche Diagnostics and Abbott Diagnostics; has served on endpoint committees for
Siemen’s Health Care and Radiometer; has received consulting income from Roche Diagnostics; and has received honoraria for participation in
the data and safety monitoring board or steering committees of Novo Nordisk, St. Jude Medical, and Amgen. Dr. Kremers has equity (<$20,000)
in Boston Scientific; provides consulting for Medtronic; and is a member of the Speakers Bureau for Boston Scientific. Dr. Messenger is an
investigator in clinical research studies for Philips Medical Systems; and is a member of the Clinical Events Committee of Novate Medical. Dr.
Moore is a consultant for pfm Medical; is an investigator in research protocols funded by Medtronic and St. Jude Medical; and is on the medical
advisory boards for 480 BioMedical and Transmural Systems. Dr. Curtis receives salary support through a contract with the American College of
Cardiology to provide data analytic services and from the Centers for Medicaid & Medicare Services; and has equity in Medtronic. Dr. Roe has
received research funding from Eli Lilly, Sanofi, Daiichi-Sankyo, Janssen Pharmaceuticals, Ferring Pharmaceuticals, Myokardia, AstraZeneca,
American College of Cardiology, American Heart Association, and Familial Hypercholesterolemia Foundation; and has received consulting fees or
honoraria from PriMed, AstraZeneca, Boehringer Ingelheim, Merck, Actelion, Amgen, Myokardia, Eli Lilly, Novartis, Daiichi-Sankyo, Quest
Diagnostics, and Elsevier Publishers. Dr. Spertus is affiliated with the Saint Luke’s Mid America Heart and Institute, which is the major analytic
center for the PINNACLE program and receives funding from the American College of Cardiology for this role; is on the Scientific Advisory Board
of United Healthcare; provides consulting services for United Healthcare, Novartis, Amgen, and Bayer (all moderate); has copyright to the Kansas
City Cardiomyopathy Questionnaire, Seattle Angina Questionnaire, and the Peripheral Artery Questionnaire (significant); has received grants
from Gilead, Lilly, Novartis, and Abbott Vascular (all significant); and has equity in Health Outcomes Sciences (significant). All other authors
have reported that they have no relationships relevant to the contents of this paper to disclose.
Manuscript received December 16, 2016; accepted December 16, 2016.
Masoudi et al.
JACC VOL. 69, NO. 11, 2017
MARCH 21, 2017:1424–6
NCDR Cardiovascular Care Executive Summary
as the basis for cardiovascular health services and epide-
graft surgery was 0.2% (vs. 0.3% in 2011), and of
miology research that informs contemporary clinical care.
vascular access site injury was 1.3% (vs. 1.2% in 2011).
This report provides a summary of key findings from 4
established hospital programs: CathPCI (Diagnostic Cath-
ICD REGISTRY
eterization and Percutaneous Coronary Intervention)
capturing data on coronary angiography and percuta-
n
In 2014, the program collected data on 158,649
neous coronary interventions; ACTION-GWTG (Acute
patients receiving an ICD of whom 120,228 received a
Coronary
Outcomes
device for a primary prevention indication and 38,421
Network–Get With The Guidelines) for acute myocardial
for a secondary prevention indication; 91,000 of all
Treatment
and
Intervention
procedures represented initial generator implants.
infarction; ICD (Implantable Cardioverter-Defibrillator)
for implantable cardioverter-defibrillators and cardiac
n
A total of 1,715 hospitals submitted data to the ICD
resynchronization therapy; and IMPACT (Improving Pe-
Registry (21% were rural and 36% teaching hospitals);
diatric and Adult Congenital Treatment) for catheteriza-
hospital ICD procedural volume ranged from <25 (in
tion procedures for congenital heart disease in children
457 participating hospitals) to more than 150 (229
participating hospitals).
and adults. A more complete report is published separately (1). Data from the ambulatory programs and those
n
Among physicians implanting ICDs, 81.7% were board
focusing on newly adopted technologies will be reported
certified in clinical cardiac electrophysiology or had
separately or will be included in future reports. The data
completed
provided reflect care in 2014 and, in some cases, include
fellowship.
temporal trends since 2011. NCDR data provide a unique,
n
adult
or
pediatric
electrophysiology
Of all implants in 2014, 25% involved a single-chamber
clinically rich national perspective on the care and out-
device, 32% dual-chamber devices, and 43% cardiac
comes of high-impact cardiovascular conditions and pro-
resynchronization defibrillators. In 2011, 19% of pro-
cedures that are not available elsewhere.
cedures
involved
a
single-chamber
device;
37%
employed a dual-chamber device, and 44% were cardiac resynchronization defibrillators.
CathPCI REGISTRY
n
Rates of use of individual evidence-based therapies are
generally high; however, performance on a composite
n
n
n
In 2014, the program collected data on 667,424 patients
medication metric, including angiotensin-converting
undergoing percutaneous coronary intervention (PCI),
enzyme inhibitors or angiotensin receptor blockers for
of which 35.3% procedures were performed for elective
patients with left ventricular systolic dysfunction
indications and 64.7% performed for nonelective
(LVSD) and beta-blockers for those with LVSD or prior
indications.
myocardial infarction, was 80.3% in 2014 compared
A total of 1,612 hospitals submitted data to CathPCI
with 76.7% in 2011, identifying an important target for
(20% were rural and 34% were teaching hospitals).
quality improvement.
Between 2011 and 2014, the use of femoral access
declined (from 88.8% to 74.5%) and radial access
ACTION-GWTG REGISTRY
increased (from 10.9% to 25.2%).
n
Rates of use of evidence-based therapies, including
n
with acute myocardial infarction, of whom 71,368 had
patients
STEMI and 111,535 had non–ST-segment elevation acute
are
high
(performance
for
a
composite
coronary syndromes.
measure of all medications of 89.1% in 2011 and 93.3%
in 2014).
n
n
was 59 min for patients receiving PCI in the presenting
n
A total of 907 hospitals submitted data to ACTIONGWTG; 19% were rural and 36% were teaching
In 2014, median door-to-balloon time for primary PCI
hospitals.
for ST-segment elevation myocardial infarction (STEMI)
n
In 2014, the program collected data on 182,903 patients
aspirin, P2Y 12 inhibitors, and statins for eligible
n
Although performance on many measures was high for
hospital and 105 min for patients transferred from
many metrics, exceptions include overall defect-free
another facility for therapy.
care (median hospital performance rate of 78.4% in
The use of mechanical circulatory support during a PCI
2014); P2Y 12 inhibitor use in eligible medically-treated
procedure was stable between 2011 and 2014 (3.1% in
patients (56.7%); and the use of aldosterone antago-
both time periods).
nists in patients with LVSD and either diabetes or heart
In 2014, the unadjusted rate of acute kidney injury was
2.6% (vs. 2.3% in 2011), of blood transfusion was 1.4%
failure (12.8%).
n
Among eligible patients with STEMI, 95.8% underwent
(vs. 1.9% in 2011), of post-procedural stroke was 0.2%
coronary angiography and 90.7% underwent PCI.
(vs. 0.2% in 2011), of emergency coronary artery bypass
Among
those
with
non–ST-segment
elevation
1425
1426
Masoudi et al.
JACC VOL. 69, NO. 11, 2017
MARCH 21, 2017:1424–6
NCDR Cardiovascular Care Executive Summary
myocardial infarction (NSTEMI), 81.9% underwent
Aortic coarctation balloon angioplasty was less often
coronary angiography and 52.4% underwent PCI.
n
successful (55.1%).
Patients with STEMI were more likely to experience
n
Device embolization was reported in 1.2% of atrial
certain adverse events during hospitalization compared
septal defect closure procedures and 1.1% of patent
with those with NSTEMI, including death (6.4% for STEMI,
ductus arteriosus closure procedures; a clinically sig-
3.4% for NSTEMI), cardiogenic shock (4.4% vs. 1.6%,
nificant increase in aortic regurgitation after valvulo-
respectively), or bleeding (8.5% vs. 5.5%, respectively).
plasty was reported in 10.6% of cases.
CONCLUSIONS
IMPACT REGISTRY
NCDR programs provide unique opportunities to advance
n
n
In 2014, the program collected data on 20,169 patients
the understanding of care for cardiovascular disease in the
with congenital heart disease undergoing cardiac
United States. These programs collect data for a broad
catheterization
of
range of patients in geographically and structurally diverse
whom 86.0% were younger than age 18 years and 24.6%
care settings, and they characterize the clinical care and
were younger than age 1 year.
outcomes of patients with high-impact cardiovascular
A total of 76 hospitals submitted data to the IMPACT
conditions or undergoing common cardiovascular.
or
catheter-based
intervention,
Registry (19% rural and 36% teaching hospitals).
n
septal
defect
ADDRESS FOR CORRESPONDENCE: Dr. Frederick A.
closure,
aortic
Masoudi, 12401 East 17th Avenue, Room 522, Campus Box
coarctation stenting, and pulmonary valvuloplasty
B132, Aurora, Colorado 80045. E-mail: fred.masoudi@
were performed with success rates exceeding 84%.
ucdenver.edu.
Many
procedures,
closure,
patent
including
ductus
atrial
arteriosus
REFERENCE
1. Masoudi FA, Ponirakis A, de Lemos JA, et al. Trends
in U.S. Cardiovascular Care: 2016 Report from 4 ACC
National Cardiovascular Data Registries. J Am Coll
Cardiol. 2017;69:1427–50.
KEY WORDS acute coronary syndromes,
congenital heart disease, implantable
cardioverter-defibrillators, percutaneous
coronary intervention, quality of care