Nav: Home

Report highlights national trends in heart disease treatments

January 17, 2017

Over 93 percent of heart attack patients are receiving stents within the guideline-recommended threshold of 90 minutes after arriving at the hospital, with the median time to stenting only 59 minutes, according to a broad report on trends in heart disease care from the American College of Cardiology's National Cardiovascular Data Registry published in the Journal of the American College of Cardiology.

The report "Trends in Cardiovascular Care in the United States: a Report from Four American College of Cardiology National Cardiovascular Data Registry Programs" provides insights into the patient populations, participating centers and patterns of care based on 2014 data from 4 of the 10 NCDR programs - CathPCI Registry, ICD Registry, ACTION Registry-GWTG and IMPACT Registry.

The authors of the report said the registry data provide unique perspectives into the care and outcomes of heart disease care in the U.S. and illustrate the strength of national quality programs, like NCDR, in advancing the effectiveness and safety of treatments for heart disease patients.

"We were able to report on the care and outcomes of patients undergoing common cardiovascular procedures, including percutaneous coronary interventions, implantable defibrillators, and interventions for congenital heart disease as well as for patients with acute heart attacks," NCDR Management Board Chair and lead author of the study Frederick A. Masoudi, MD, MSPH, FACC , said. "In some cases, hospitals are consistently providing excellent care; the registries, however, allow us to identify those aspects of care where the cardiovascular clinical community can improve."

Key findings from each registry include:

CathPCI Registry

  • Of the 667,424 patients undergoing PCI in 2014, 35.3 percent of PCIs were performed for elective indications, compared to 64.7 percent performed for non-elective indications.

  • Between 2011 and 2014, the use of femoral access decline from 88.4 percent to 74.5 percent, while the use of radial access increased from 10.9 percent to 25.2 percent.

  • Use of evidence-based therapies, including aspirin, P2Y12 inhibitors and statins for eligible patients, continue to remain high at 93.3 percent.

  • Median door-to-balloon time for primary PCI for STEMI also remains strong at 59 minutes for patients receiving PCI at the presenting hospital and 105 minutes for transfer patients.

ICD Registry

  • Of the 158,649 patients receiving ICD therapy in 2014, 120,228 received a device for primary prevention reasons, compared to 38,421 who received a device for secondary prevention indications.

  • Of all ICD implants in 2014, 25 percent involved single chamber devices, 32 percent involved dual chamber devices and 43 percent involved CRT-D devices, compared to 19 percent, 37 percent and 44 percent, respectively, in 2011.

  • While use of evidence-based therapies are generally high, performance on a composite medication metric, including use of ACE or ARB for patients with LVSD and beta blockers for patients with LVSD, could be a target for quality improvement efforts. Between 2011 and 2014 the composite rate of use grew from 76.7 percent to 80.3 percent, with room for continued improvement.

ACTION Registry-GWTG

  • Of the 182,903 patients with acute myocardial infarction (AMI) in 2014, 71,368 had ST-segment elevation MI (STEMI), while 111,535 had non-ST-segment elevation acute coronary syndromes (NSTEMI).

  • There is room for improvement in the areas of overall defect-free care (78.4 percent); P2Y12 inhibitor use in eligible patients (56.7 percent); and use of aldosterone antagonists in patients with LV systolic dysfunction and either diabetes or heart failure (12.8 percent).

  • Compared to NSTEMI patients, STEMI patients were more likely to experience certain adverse events during hospitalization, including death (6.4 percent vs. 3.4 percent); cardiogenic shock (4.4 percent vs. 1.6 percent), or bleeding (8.5 percent vs. 5.5 percent).

  • Of the STEMI patients, 95.8 percent underwent coronary angiography and 90.7 percent underwent PCI, compared to NSTEMI patients of which 81.9 percent underwent coronary angiography and 52.4 percent underwent PCI.

IMPACT Registry

  • Of the 20,169 patients with congenital heart disease undergoing cardiac catheterization or a catheter-based intervention, 86 percent were under the age of 18 and 24.6 percent were under one year old.

  • Procedures such as atrial septal defect (ASD) closure, patent ductus arteriosus (PDA) closure, aortic coarctation stenting and pulmonary valvulolasty had success rates exceeding 84 percent. Aortic coarctation balloon angioplasty was less successful at 55.1 percent.

  • Device embolization was reported in 1.2 percent of ASD closure procedures and 1.1 percent of PDA closure procedures. A clinically significant increase in aortic regurgitation follow valvuloplasty was noted in 10.6 percent of cases.

In a corresponding executive summary also published in JACC, Masoudi said "NCDR data provide a unique, clinically rich national perspective on the care and outcomes of high-impact cardiovascular conditions and procedures that are not available elsewhere."
-end-
The American College of Cardiology is a 52,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more, visit acc.org.

The Journal of the American College of Cardiology is the most widely read cardiovascular journal in the world and is the top ranked cardiovascular journal for its scientific impact. JACC is the flagship for a family of journals that publish peer-reviewed research on all aspects of cardiovascular disease. JACC: Cardiovascular Interventions, JACC: Cardiovascular Imaging and JACC: Heart Failure also rank among the top ten cardiovascular journals for impact. JACC: Clinical Electrophysiology and JACC: Basic to Translational Science are the newest journals in the JACC family. Learn more at JACC.org.

American College of Cardiology

Related Congenital Heart Disease Articles:

Faulty signalling pathway linked to congenital heart condition
Faulty signalling pathway causes the heart to develop unnaturally while in the embryo stage, according to Duke-NUS Medical School researchers.
Uncorrected congenital heart disease may lead to increased risks in pregnant women
Pregnant women with congenital heart disease (CHD) who have not had surgery to repair their cardiac condition are more likely to experience cardiac events or maternal death, especially those with certain conditions in emerging countries, according to a study published Oct.
A new framework to study congenital heart defects
In a new study published in the scientific journal Nature, a team of researchers at the Gladstone Institutes, in collaboration with the University of Luxembourg, reveal for the first time the full spectrum of cells that come together to make a heart at the earliest stages of embryo formation.
Risk of cancer among children, young adults with congenital heart disease
National registry data in Sweden were used in this study that assessed the risk of developing cancer in children and young adults with congenital heart disease compared with healthy people in the general population from birth to age 41.
Congenital heart defects vastly increase risk of heart problems later in life
An infant born with a relatively simple heart defect is far more likely to develop heart problems as an adult, researchers at the Stanford University School of Medicine have discovered.
Human milk is a 'life-saving intervention' for infants with congenital heart disease
With a lower risk of serious complications and improved feeding and growth outcomes, human milk is strongly preferred as the best diet for infants with congenital heart disease (CHD), according to a research review in Advances in Neonatal Care, official journal of the National Association of Neonatal Nurses.
Climate change may increase congenital heart defects
The rise in temperatures stemming from climate change may increase the number of US infants born with congenital heart defects between 2025 and 2035.
Worse outcomes for Hispanic infants with critical congenital heart disease
Hispanic infants born with critical types of heart disease had significantly worse one-year outcomes than infants born to white mothers.
UA study: Sleep apnea, congenital heart disease may be deadly mix for hospitalized infants
Infants with congenital heart disease and central sleep apnea are four times more likely to die in the hospital, researchers find.
Newborns with congenital heart disease have enlarged kidneys
The hearts and brains of babies born with congenital heart disease are not the only organs affected by this common medical condition.
More Congenital Heart Disease News and Congenital Heart Disease Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.