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Trends in U.S. Ambulatory Cardiovascular Care 2013 to 2017: JACC Review Topic of the Week
Thomas M Maddox1, Yang Song2, Joseph Allen3
1Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri; Healthcare Innovation Lab, BJC HealthCare/Washington University School of Medicine; St. Louis, Missouri.
Insights
The Practice Innovation and Clinical Excellence (PINNACLE) Registry shows improved cardiovascular care for heart failure, coronary artery disease, and atrial fibrillation patients. However, blood pressure control for hypertension remained stable.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Clinical Quality Improvement
Background:
- The National Cardiovascular Data Registry PINNACLE (Practice Innovation and Clinical Excellence) Registry is the world's largest outpatient cardiovascular practice registry.
- It collects data on the real-world management and quality of care for four common cardiovascular conditions: heart failure, coronary artery disease, atrial fibrillation, and hypertension.
Purpose of the Study:
- To assess trends in cardiovascular care processes and outcomes using data from the PINNACLE Registry.
- To evaluate changes in medication adherence and clinical targets over time.
Main Methods:
- Analysis of de-identified patient data from the PINNACLE Registry between 2013 and 2017.
- Tracking of key performance metrics, including medication rates and blood pressure control.
Main Results:
- Significant improvements were observed in medication rates for heart failure (beta-blocker and renin-angiotensin antagonist use increased from 60.7% to 72.8%) and coronary artery disease (statin use increased from 66% to 80.1%).
- Oral anticoagulation rates for atrial fibrillation also increased from 52.7% to 65.2%.
- Blood pressure control rates for hypertension showed minimal change during the study period.
Conclusions:
- The PINNACLE Registry demonstrates progress in guideline-directed medical therapy for several cardiovascular conditions.
- Sustained focus is needed to improve hypertension management and control.
- The registry data supports quality improvement initiatives and has generated substantial peer-reviewed research.
Abstract:
The National Cardiovascular Data Registry PINNACLE (Practice Innovation and Clinical Excellence) Registry is the largest outpatient cardiovascular practice registry in the world. It tracks real-world management and quality of 4 common cardiovascular conditions: heart failure, coronary artery disease, atrial fibrillation, and hypertension. In 2013, the PINNACLE Registry contained information on 2,898,505 patients, cared for by 4,859 providers in 431 practices. By 2017, the registry contained information on 6,040,996 patients, cared for by 8,853 providers in 724 practices. During this time period, care processes for PINNACLE patients generally improved. Among patients with heart failure, combined beta-blocker and renin-angiotensin antagonist medication rates increased from 60.7% to 72.8%. Among patients with coronary artery disease, statin medication rates increased from 66% to 80.1%. Among patients with atrial fibrillation, oral anticoagulation rates increased from 52.7% to 65.2%. In contrast, blood pressure control rates among patients with hypertension were largely stable. PINNACLE data also fueled a variety of quality measurement programs and 51 peer-reviewed publications.
