July 13, 2010 – A new analysis from the American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR) shows that hospitals across the country are making improvements in the care of patients who have a heart attack or undergo percutaneous coronary intervention (PCI) procedures to unblock clogged coronary arteries. More than ever before, cardiac patients are receiving proven therapies quickly, safely and according to clinical guidelines, the new data show.
The NCDR comprises a suite of data registries that involve more than 2,400 hospitals and more than 10.6 million patient records. The new NCDR analysis appears in the July 20, 2010, issue of the Journal of the American College of Cardiology.
“This study shows that as a country, we do a good job in treating patients with heart attacks,” said John S. Rumsfeld, M.D., Ph.D., chief science officer and chair of the NCDR and acting national director of cardiology for the Veterans Affairs Health Administration. “More patients with heart attacks qualify for urgent angioplasty and stenting, and they are getting it quicker. There have also been improvements in giving recommended medications to heart attack patients—many of which reduce the risk of death and long-term complications.”
Equally impressive are the results for coronary angioplasty and stenting. These procedures, which fall under the umbrella term percutaneous coronary intervention (PCI), involve threading a slender tube into the arteries of the heart, expanding a tiny balloon to widen the artery and, usually, leaving an expandable metal stent in place to hold the artery open.
The data analysis showed significant improvements in several key aspects of heart attack care, including:
• Increase from 90.8 percent to 93.8 percent in the use of treatments to restore blood flow to the heart in patients with ST segment elevation myocardial infarction (STEMI) heart attacks;
• Increase from 64.5 percent to 88 percent in the number of patients with STEMI heart attacks treated with PCI within 90 minutes of arriving at the hospital—a key quality benchmark;
• Improvement from 89.6 percent to 92.3 percent in overall performance scores that measure timeliness and appropriateness of therapy for STEMI heart attacks;
• Improvement in achieving correct dosing of several types of “blood thinners” among non-ST segment elevation myocardial infarction (NSTEMI) patients;
• Reduction from 6.2 percent to 5.5 percent in risk-adjusted hospital death rates among STEMI patients and from 4.3 percent to 3.9 percent among NSTEMI patients; and
• Improvement in prescribing guidelines-recommended medications, including aspirin, clopidogrel, statins, beta blockers and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, as well as in counseling patients to stop smoking and referring patients to cardiac rehabilitation.
Patients are also taking important steps toward improving heart attack care by heeding the warning signs of heart attack, the data reveal. The time from the beginning of heart attack symptoms to the patient’s arrival at the hospital dropped significantly during the study period, from 1.7 hours to 1.5 hours, on average.
“Patients are coming to the hospital sooner,” Rumsfeld said. “That shows a greater awareness by the public that if you have unexplained chest pain or shortness of breath, you need to get to the hospital quickly. The sooner you get treatment for a heart attack, the better your chances of survival and the less likely you are to experience long-term complications like heart failure.”
The data analysis revealed several notable trends, including:
• Increase in procedural complexity, including treatment of significantly more patients with challenging “type C” lesions;
• Reduction in complications related to bleeding or injury to the arteries used for passing tubes to the heart;
• Changes in the use of medications designed to prevent unwanted blood clots, reflecting the results of recent clinical trials and recommendations from new clinical practice guidelines; and
• Reduction in the overall use of drug-eluting stents, partially balanced by increased use of new types of drug-eluting stents.
In addition to its encouraging findings, the analysis also highlights specific areas in need of improvement and identifies targets for future research, particularly those aimed at reducing the bleeding risk associated with even the best therapies.