Key result
Implementation of the NCDR ACTION Registry for STEMI management significantly reduced adjusted mortality from 9.04% to 5.92% (P=0.027) and improved optimal door-to-balloon times.
Why the study?
The study aimed to examine the effect of benchmarking through the ACC NCDR ACTION Registry on quality-of-care metrics in patients presenting with STEMI.
Does the implementation of a benchmarking registry improve quality-of-care metrics and clinical outcomes in patients with STEMI?
Observational (n=712)
Yes
Does the implementation of a benchmarking registry improve quality-of-care metrics and clinical outcomes in patients with STEMI?
Absolute Event Rate: 5.92% vs 9.04%
p-value: p=0.027
Implementation of a benchmarking registry for STEMI care significantly improved process metrics, such as door-to-balloon time and guideline-directed medical therapy, and was associated with reduced mortality.
May support benchmarking for STEMI quality gains; leaves open causal effects and broader generalizability.
OBJECTIVE: We aim to examine the effect of benchmarking on quality-of-care metrics in patients presenting with ST-elevation myocardial infarction (STEMI) through the implementation of the American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) ACTION Registry. DESIGN: From January 2005 to December 2017, 712 patients underwent primary percutaneous coronary intervention PCI-499 before NCDR ACTION Registry implementation (prior to 2013) and 213 after implementation. SETTING: STEMI. PARTICIPANTS: 712 patients. INTERVENTION(S): Primary PCI. MAIN OUTCOME MEASURE(S): We examined hospital performance for the quality indicators in processes and outcomes of the management of patients presenting with STEMI. Outcome measures include door-to-balloon time (DBT), antiplatelet therapy and anti-ischemic drugs prescribed at discharge from pre-NCDR ACTION Registry to post-implementation. RESULTS: There was improvement in DBT, decreasing from 94 min in 2012 (before NCDR adoption) to reach a median of 47 min in 2017 (Ptrend < 0.001). The percentage of cases with the optimal DBT of < 90 min increased from 55.8% before to 90.1% after the implementation of the NCDR ACTION Registry (Ptrend < 0.001). The rate of aspirin (90.3-100%, P < 0.001), P2Y12 inhibitor (70.1-78.4%, P = 0.02), beta-blocker (76.8-100%, P < 0.001) and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (60.1-99.5%, P < 0.001) prescribed at discharge increased from pre-NCDR ACTION Registry to post-implementation. Adjusted mortality before and after NCDR ACTION Registry implementation showed significant change (from 9.04 to 5.92%; P = 0.027). CONCLUSIONS: The introduction of the ACC NCDR ACTION Registry led to incremental gains in the quality in STEMI management through the benchmarking of process of care and clinical outcomes, achieving reduced DBT, improving guideline-directed medication adherence and increasing patient safety, treatment efficacy and survival.
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Caixeta et al. (2019) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=712). NCDR ACTION Registry implementation vs. Pre-NCDR ACTION Registry implementation was evaluated on Adjusted mortality (p=0.027). Implementation of the NCDR ACTION Registry for STEMI management significantly reduced adjusted mortality from 9.04% to 5.92% (P=0.027) and improved optimal door-to-balloon times.
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