Transcript 2006 AHA Secondary Prevention Guidelines Slide Set

CVD Prevention Guidelines:
Design and Implementation
Nathan D. Wong, PhD, FACC, FAHA
Professor and Director
Heart Disease Prevention Program
Division of Cardiology
University of California, Irvine, CA USA
President, American Society for Preventive Cardiology
1
Scientific Statements
- increase knowledge and awareness by
healthcare professionals of effective, stateof-the art science related to the causes,
prevention, detection, or management of
cardiovascular diseases and stroke.
- represent the consensus of the leading
experts in cardiovascular disease and
stroke.
- undergo blinded peer review and are
reviewed and approved by the AHA Science
Advisory and Coordinating Committee
(SACC), the highest scientific body of the
AHA.
2
Guidelines
• The Institute of Medicine defines a guideline as
“systematically developed statements to assist
practitioner and patient decisions about
appropriate health care for specific clinical
circumstances.”
• The AHA often develops practice guidelines in
conjunction with the American College of
Cardiology (ACC), but also may develop them
alone or in partnership with other organizations
as appropriate.
• All guidelines adhere to the levels of evidence
and classes of recommendation as established
by the ACC/AHA Guidelines Task Force.
• All guidelines undergo peer review and are
reviewed and approved by the AHA SACC.
3
Overview of AHA CVD
Prevention Guidelines
• Diet and Lifestyle Recommendations: Revision
2006
• AHA/ACC Guidelines for Secondary Prevention for
Patients With Coronary and Other Atherosclerotic
Vascular Disease: 2006 Update
• Guidelines for Prevention of Stroke in Patients
With Ischemic Stroke or Transient Ischemic Attack
• American Heart Association Guide for Improving
Cardiovascular Health at the Community Level
• AHA Guidelines for Primary Prevention of
Cardiovascular Disease and Stroke: 2002 Update
• Heart Association Guidelines for Weight
Management Programs for Healthy Adults
4
Overview of ACCF/AHA
Performance Measurement Sets
5
Attributes of Performance
Measures
6
Classification of Recommendations
and Levels of Evidence
7
Applying Classification of
Recommendations and Level of
Evidence
Class I
Class IIa
Class IIb
Class III
Benefit >>> Risk
Benefit >> Risk
Additional studies
with focused
objectives needed
Benefit ≥ Risk
Additional studies
with broad
objectives needed;
Additional registry
data would be
helpful
Risk ≥ Benefit
No additional studies
needed
Procedure or
treatment SHOULD
be performed or
administered
IT IS REASONABLE
to perform
procedure or
administer
treatment
Procedure or
treatment
MAY BE
CONSIDERED
Procedure or
treatment should
NOT be performed or
administered SINCE
IT IS NOT HELPFUL
AND MAY BE
HARMFUL
8
Applying Classification of
Recommendations and Level of
Evidence
Level A
Class I
Class IIa
Class IIb
Class III
Multiple (3-5)
population risk
strata evaluated
Recommendation
that procedure
or treatment is
useful/ effective
Recommendation
in favor of
treatment or
procedure being
useful/ effective
Recommendation’
s usefulness/
efficacy less well
established
Recommendation
that procedure
or treatment not
useful/ effective
and may be
harmful
General
consistency of
direction and
magnitude of
effect
Sufficient
evidence from
multiple
randomized
trials or metaanalyses
Some conflicting
evidence from
multiple
randomized
trials or metaanalyses
Greater
conflicting
evidence from
multiple
randomized
trials or metaanalyses
Sufficient
evidence from
multiple
randomized
trials or metaanalyses
9
Applying Classification of
Recommendations and Level of
Evidence
Level B
Limited (2-3)
population risk
strata evaluated
Class I
Class IIa
Class IIb
Recommendation that
procedure or
treatment is
useful/ effective
Recommen-dation
in favor of
treatment or
procedure being
useful/ effective
Recommendation’s
usefulness/
efficacy less well
established
Limited evidence
from single
randomized trial
or nonrandomized
studies
Some conflicting
evidence from
single
randomized trial
or nonrandomized
studies
Greater conflicting
evidence from
single
randomized trial
or nonrandomized
studies
Class III
Recommen-dation
that procedure or
treatment not
useful/effective
and may be
harmful
Limited evidence
from single
randomized trial
or nonrandomized
studies
10
Applying Classification of
Recommendations and Level of
Evidence
Level C
Very limited (1-2)
population risk
strata evaluated
Class I
Recommendation that
procedure or
treatment is
useful/ effective
Only expert
opinion, case
studies, or
standard-ofcare
Class IIa
Class IIb
Recommendation
in favor of
treatment or
procedure being
useful/effective
Recommendation’s
usefulness/
efficacy less well
established
Only diverging
expert opinion,
case studies, or
standard-of-care
Only diverging
expert opinion,
case studies, or
standard-of-care
Class III
Recommendation
that procedure or
treatment not
useful/effective
and may be
harmful
Only expert
opinion, case
studies, or
standard-of-care
11
AHA / ACCF Primary Prevention Revised
Statement September 2009
Circulation, September 2009
12
13
Lifestyle / Risk Factor Screening
Numerator = Patients with assessment of diet
and physical activity occurred in the past 2 years
Denominator = Patients aged 8-80 years at
beginning of assessment period
14
Dietary Intake Counseling
Numerator = Patients who were advised to eat
a healthy diet at least once in the past 2 years
Denominator – All patients 18 to 80 years of
age at start of the measurement period
15
AHA Scientific Statement: Diet and
Lifestyle Recommendations Revision 2006
16
Physical Activity Counseling
Numerator = Patients who were advised at least
once within the past 2 years to engage in regular
physical activity
Denominator – All patients 18 to 80 years of age at
start of the measurement period
17
Smoking / Tobacco Use
Numerator = Patients who were queried about
tobacco use 1 or more times in the past 2 years
Denominator – All patients 18 years of age or
over at start of the measurement period
18
Smoking / Tobacco Cessation
Numerator = Patients identified as tobacco users
who received cessation intervention
Denominator = All patients aged 18 years and over
at start of measurement period identified as tobacco
19
users
Weight / Adiposity Assessment
Numerator = Patients for whom weight and
BMI and/or WC is documented at least once in
the last 2 years
Denominator = All patients 18-80 years of age
at start of measurement period
20
Weight Management
Numerator = All patients who were counseled
on weight management at least once within
the past 2 years
Denominator = All patients 18-80 years of age
at start of measurement period with BMI >30
or WC >102 cm (men) or >88 cm (women)
21
Blood Pressure Measurement
Numerator = Patients for whom blood pressure
measurement was recorded at least once in the past
2 years
Denominator = All patients aged 18-80 years at
22
Blood Pressure Control
Numerator: Patients aged 18-80 years of age with
HTN who had a recorded BP reading <140/90 mmHg
or who were prescribed 2+ medications
Denominator: Patients with HTN diagnosed for at
least 6 months
23
Blood Lipid Measurement
Numerator = Patients with at least 1 fasting lipid profile
performed within the past 5 years
Denominator = Men aged 35-80 or Women aged 45-80
with at least 1 risk factor, 2+ visits
24
Blood Lipid Therapy and Control
Numerator = Patients whose most recent LDL-C (mg/dl)
was <190 (<10% risk women), <160 (<10% low risk
men), <130 (10-20% risk), <100 (>20% risk), or
prescribed maximal lipid therapy
Denominator = Patients with a fasting lipid profile and
risk assessment
25
Global Risk Estimation
Numerator (quality improvement only): patients for
whom 10-year risk of CHD is recorded at least once in the
last 5 years
Denominator: Men aged 35-80 and women 45-80 free of
CHD but with at least one risk factor
26
Aspirin use
Numerator ( internal quality improvement only): men
aged 35-80 or women 45-80 advised to use aspirin
Denominator: All men 35-80 or women 45-80 without
CVD but with estimated 10-year CHD risk >=20%
27
28
29
30
31
AHA Secondary Prevention for Patients
with Coronary Artery and Other
Atherosclerotic Vascular Disease
Circulation 2006;113:2363-2372 and
J Am Coll Cardiol 2006;47:2130-2139
32
Introduction
• Since the 2001 update of the AHA/ACC consensus
statement on secondary prevention, important evidence
from clinical trials has emerged that further supports and
broadens the merits of aggressive risk reduction therapies
• This growing body of evidence confirms that aggressive
comprehensive risk factor management improves survival,
reduces recurrent events and the need for interventional
procedures, and improves the quality of life
• The secondary prevention patient population includes
those with established coronary and other atherosclerotic
vascular disease, including peripheral arterial disease,
atherosclerotic aortic disease and carotid artery disease.
33
Secondary Prevention Definition
• Therapy to reduce recurrent cardiovascular events and
decrease cardiovascular mortality in patients with
established atherosclerotic vascular disease
• Patients covered include those with established
coronary and other atherosclerotic vascular disease,
including peripheral arterial disease, atherosclerotic aortic
disease and carotid artery disease
• Individuals with sub-clinical atherosclerosis and patients
whose only manifestation is diabetes are covered in other
guidelines
34
Components of Secondary
Prevention
Cigarette smoking cessation
Blood pressure control
Lipid management to goal
Physical activity
Weight management to goal
Diabetes management to goal
Antiplatelet agents / anticoagulants
Renin angiotensin aldosterone system blockers
Beta blockers
Influenza vaccination
35
Evidence Based Therapies
The writing group emphasizes the importance of giving
consideration to the use of cardiovascular medications
that have been proven to be of benefit in randomized
clinical trials.
This approach strengthens the evidence-based
foundation for therapeutic application of these
guidelines.
The committee acknowledges that in many trials there is
under-representation of ethnic minorities, women, and
the elderly.
36
Cigarette Smoking
Recommendations
Goal: Complete Cessation and No
Exposure to Environmental
Tobacco Smoke
•Ask about tobacco use status at every visit.
•Advise every tobacco user to quit.
•Assess the tobacco user’s willingness to quit.
I IIa IIb III
•Assist by counseling and developing a plan for
quitting.
•Arrange follow-up, referral to special programs,
or pharmacotherapy (including nicotine
replacement and bupropion.
•Urge avoidance of exposure to environmental
tobacco smoke at work and home.
37
Blood Pressure Control
Recommendations
Goal: <140/90 mm Hg or <130/80 if
diabetes or chronic kidney disease
I IIa IIb III
I IIa IIb III
Blood pressure 120/80 mm Hg or greater:
Initiate or maintain lifestyle modification: weight control,
increased physical activity, alcohol moderation, sodium
reduction, and increased consumption of fresh fruits
vegetables and low fat dairy products
Blood pressure 140/90 mm Hg or greater (or 130/80
or greater for chronic kidney disease or diabetes)
As tolerated, add blood pressure medication, treating
initially with beta blockers and/or ACE inhibitors with
addition of other drugs such as thiazides as needed to
achieve goal blood pressure
38
Lipid Management Goal
I IIa IIb III
LDL-C should be less than 100 mg/dL
I IIa IIb III
Further reduction to LDL-C to < 70 mg/dL
is reasonable
If TG >200 mg/dL, non-HDL-C should be < 130 mg/dL*
*Non-HDL-C = total cholesterol minus HDL-C
39
Lipid Management Goals: NCEP
Risk Category
High risk:
CHD or CHD risk
equivalents
(10-year risk >20%)
and
Very high risk:
ACS or established CHD
plus: multiple major risk
factors (especially
diabetes) or severe and
poorly controlled risk
factors
Consider
Drug Therapy
LDL-C and nonHDL-C Goal
Initiate TLC
<100 mg/dL
if TG > 200 mg/dL,
non-HDL-C
should be < 130
mg/dL
100
mg/dL
>100 mg/dL
(<100 mg/dL: consider
drug options)
<70 mg/dL,
non-HDL-C < 100
mg/dL
All patients
>100 mg/dL
(<100 mg/dL: consider
drug options)
ATP=Adult Treatment Panel, CHD=Coronary heart disease, LDL-C=Low-density lipoprotein
cholesterol, TLC=Therapeutic lifestyle changes
Grundy, S. et al. Circulation 2004;110:227-39.
40
Lipid Management
Recommendations
For all patients
I IIa IIb III
Start dietary therapy (<7% of total calories as
saturated fat and <200 mg/d cholesterol)
Adding plant stanol/sterols (2 gm/day) and
viscous fiber (>10 mg/day) will further lower LDL
I IIa IIb III
Promote daily physical activity and weight
management.
I IIa IIb III
Encourage increased consumption of omega-3
fatty acids in fish or 1 g/day omega-3 fatty acids
in capsule form for risk reduction.
41
ATP III Dietary Recommendations
Nutrient
Saturated fat*
Recommended Intake
<7% of total calories
Polyunsaturated fat
Up to 10% of total calories
Monounsaturated fat
Up to 20% of total calories
Total fat
25%–35% of total calories
Carbohydrate (esp. complex carbs)
Fiber
50%–60% of total calories
20–30 g/d
Protein
Cholesterol
~15% of total calories
<200 mg/d
*Trans fatty acids also raise LDL-C and should be kept at a low intake.
Note: Regarding total calories, balance energy intake and expenditure to maintain
desirable body weight.
ATP=Adult Treatment Panel
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA
2001;285:2486-2497.
42
Lipid Management
Recommendations
Assess fasting lipid profile in all patients, and within 24 hours of
hospitalization for those with an acute event. For patients hospitalized,
initiate lipid-lowering medication as recommended below prior to discharge
according to the following schedule:
I IIa IIb III
If baseline LDL-C > 100 mg/dL, initiate LDLlowering drug therapy
I IIa IIb III
If on-treatment LDL-C > 100 mg/dL,
intensify LDL-lowering drug therapy (may
require LDL lowering drug combination)
I IIa IIb III
If baseline is LDL-C 70 to 100 mg/dL, it is
reasonable to treat to LDL < 70 mg/dL
When LDL lowering medications are used, obtain at least a 30-40% reduction in LDL-C
levels.
43
Lipid Management
Recommendations
I IIa IIb III
If TG are 200-499 mg/dL, non-HDL-C should be
< 130 mg/dL
I IIa IIb III
Further reduction of non-HDL to < 100 mg/dL
is reasonable
Therapeutic options to reduce non-HDL-C:
More intense LDL-C lowering therapy I (B) or
Niacin (after LDL-C lowering therapy) IIa (B) or
Fibrate (after LDL-C lowering therapy) IIa (B)
I IIa IIb III
If TG are > 500 mg/dL, therapeutic options to
prevent pancreatitis are fibrate or niacin
before LDL lowering therapy; and treat LDL-C
to goal after TG-lowering therapy. Achieve
non-HDL-C < 130 mg/dL, if possible
44
Physical Activity Recommendations
Goal: 30 minutes 7 days/week,
minimum 5 days/week
I IIa IIb III
Assess risk with a physical activity history
and/or an exercise test, to guide prescription
I IIa IIb III
I IIa IIb III
Encourage 30 to 60 minutes of moderate
intensity aerobic activity such as brisk
walking, on most, preferably all, days of the
week, supplemented by an increase in daily
lifestyle activities
Advise medically supervised programs for
high-risk patients (e.g. recent acute coronary
syndrome or revascularization, HF)
45
Weight Management Recommendations
Goal: BMI 18.5 to 24.9 kg/m2
Waist Circumference: Men: < 40 inches
Women: < 35 inches
I IIa IIb III
I IIa IIb III
I IIa IIb III
Assess BMI and/or waist circumference on each visit
and consistently encourage weight maintenance/
reduction through an appropriate balance of physical
activity, caloric intake, and formal behavioral programs
when indicated.
If waist circumference (measured at the iliac crest)
>35 inches in women and >40 inches in men initiate
lifestyle changes and consider treatment strategies for
metabolic syndrome as indicated.
The initial goal of weight loss therapy should be to
reduce body weight by approximately 10 percent from
baseline. With success, further weight loss can be
attempted if indicated.
*BMI is calculated as the weight in kilograms divided by the body surface area in meters2.
Overweight state is defined by BMI=25-30 kg/m2. Obesity is defined by a BMI >30 kg/m2.
46
Diabetes Mellitus Recommendations
Goal: Hb A1c < 7%
I IIa IIb III
Lifestyle and pharmacotherapy to achieve near
normal HbA1C (<7%).
I IIa IIb III
Vigorous modification of other risk factors (e.g.,
physical activity, weight management, blood
pressure control, and cholesterol management as
recommended).
I IIa IIb III
Coordinate diabetic care with patient’s primary
care physician or endocrinologist. )
HbA1c = Glycosylated hemoglobin
47
Antiplatelet Agents / Anticoagulation
Recommendations
48
Aspirin Recommendations
I IIa IIb III
Start and continue indefinitely aspirin 75 to
162 mg/d in all patients unless
contraindicated
I IIa IIb III
For patients undergoing CABG, aspirin (100 to
325 mg/d) should be started within 48 hours
after surgery to reduce saphenous vein graft
closure
I IIa IIb III
Post-PCI-stented patients should receive 325
mg per day of aspirin for 1 month for bare
metal stent, 3 months for sirolimus-eluting
stent and 6 months for paclitaxel-eluting stent
49
Clopidogrel Recommendations
Start and continue clopidogrel 75 mg/d
in combination with aspirin
I IIa IIb III
for post ACS or post PCI with stent
placement patients for up to 12
months
for post PCI-stented patients
>1 month for bare metal stent,
>3 months for sirolimus-eluting stent
>6 months for paclitaxel-eluting stent
*Clopidogrel is generally given preference over Ticlopidine because of a superior safety profile
50
Anticoagulation Recommendations
I IIa IIb III
I IIa IIb III
Manage warfarin to international normalized
ratio 2.0 to 3.0 for paroxysmal or chronic
atrial fibrillation or flutter, and in post-MI
patients when clinically indicated (e.g., atrial
fibrillation, LV thrombus.)
Use of warfarin in conjunction with aspirin
and/or clopidogrel is associated with
increased risk of bleeding and should be
monitored closely
51
Renin-Angiotensin-Aldosterone
System Blockers Recommendations
52
ACE Inhibitor Recommendations
I IIa IIb III
Use in all patients with LVEF < 40%, and
those with diabetes or chronic kidney
disease indefinitely, unless contraindicated
I IIa IIb III
Consider for all other patients
I IIa IIb III
Among lower risk patients with normal LVEF
where cardiovascular risk factors are well
controlled and where revascularization has
been performed, their use may be
considered optional
ACE=Angiotensin converting enzyme, LVEF= left ventricular ejection fraction
53
Angiotensin Receptor Blocker
Recommendations
I IIa IIb III
I IIa IIb III
Use in patients who are intolerant of ACE
inhibitors with HF or post MI with LVEF less
than or equal to 40%.
Consider in other patients who are ACE
inhibitor intolerant.
I IIa IIb III
Consider use in combination with ACE
inhibitors in systolic dysfunction HF.
ACE=Angiotensin converting enzyme inhibitor, LVEF=Left Ventricular Ejection fraction, HF=Heart
failure, MI=Myocardial infarction
54
Aldosterone Antagonist
Recommendations
I IIa IIb III
Use in post MI patients, without significant
renal dysfunction or hyperkalemia, who are
already receiving therapeutic doses of an
ACE inhibitor and beta blocker, have an LVEF
< 40% and either diabetes or heart failure
*Contraindications include abnormal renal function (creatinine >2.5
mg/dL in men or >2.0 mg/dL in women) and hyperkalemia (K+ >5.0
meq/L)
ACE=Angiotensin converting enzyme inhibitor, LVEF=Left Ventricular Ejection fraction,
MI=Myocardial infarction
55
b-blocker Recommendations
56
b-blocker Recommendations
I IIa IIb III
I IIa IIb III
Start and continue indefinitely in all post MI,
ACS, LV dysfunction with or without HF
symptoms, unless contraindicated.
Consider chronic therapy for all other
patients with coronary or other vascular
disease or diabetes unless contraindicated.
*Precautions but still indicated include mild to moderate asthma or chronic obstructive pulmonary
disease, insulin dependent diabetes mellitus, severe peripheral arterial disease, and a PR
interval >0.24 seconds.
MI=Myocardial infarction, HF=Heart Failure
57
Influenza Vaccination
I IIa IIb III
Patients with cardiovascular disease
should have influenza vaccination
58
The Need to Implement Secondary
Prevention
Multiple studies of the use of these recommended therapies in
appropriate patients continue to show that many patients in whom
therapies are indicated are not receiving them in actual clinical
practice.
The AHA and ACC urge that in all medical care settings where these
patients are managed that programs to provide practitioners with
useful reminder clues based on the guidelines, and continuously
assess the success achieved in providing these therapies to the
patients who can benefit from them be implemented.
Encourage that the AHA’s Get With the Guidelines and/or ACC’s
Guidelines Applied to Practice Programs be instituted to identify
appropriate patients for therapy
59
AHA GWTG Program
GWTG is a national initiative of the AHA to improve
guidelines adherence in patients hospitalized with
cardiovascular disease.
GWTG uses collaborative learning sessions,
conference calls, e-mail and staff support to assist
hospital teams improve acute and secondary
prevention care systems.
A web-based Patient Management Tool is used for
point of care data collection and decision support,
on-demand reporting, communication and patient
education.
60
SIMPLE, ONE PAGE, ON-LINE FORM
Demographics
6 clicks
Clinical/Lab
8 clicks
Discharge
meds and
interventions
7 clicks
Interactively
checks
patient’s
data with the
AHA guidelines
61
©2001 Outcome Sciences, Inc.
Impact of AHA Get With The
Guidelines-CAD Program on
Quality of Care
Baseline
*
100
90
80
70
60
50
40
30
20
10
0
*
* 97
9796
95
93
Q1
Q2
8787
*
64656567
Aspirin
Q4
* p< 0.05 compared to baseline
*
* * 91
83
79
Q3
68
Beta Blocker ACE Inhibitor
GWTG-CAD: 123 US Hospitals n=27,825
Labresh, Fonarow et al. Circulation 2003;108:IV-722
* *
* 75
73
6770
74
*
* * 82
* 7675
70
57
Lipid Rx
Smoking
Cessation
62
Secondary Prevention Conclusions
• Evidence confirms that aggressive comprehensive
risk factor management improves survival, reduces
recurrent events and the need for interventional
procedures, and improves the quality of life for these
patients.
• Every effort should be made to ensure that patients
are treated with evidence-based, guideline
recommended, life-prolonging therapies in the
absence of contraindications or intolerance.
63
Issue/Challenge
• Patients hospitalized with cardiovascular event are at
particularly high risk for recurrent events, hospitalizations,
and cardiovascular death.
• Fortunately, there are a number of evidence based and
highly effective therapies which can significantly improve
acute long-term care outcomes and reduce recurrent
events.
• While the AHA, ACC, and ASA Guidelines provide
evidence-based recommendations for cardiovascular care,
adherence to these guidelines is both incomplete and
highly variable.
64
AHA’s Quality Portfolio
AHA Quality Improvement Programs:
• Get With The Guidelines-Stroke
• Get With The Guidelines-Heart Failure
• ACTION Registry-- GWTG
• Get With The Guidelines-Outpatient (November 2009)
• Mission: Lifeline
• National Registry of CPR
Co-promoted programs associated with AHA/ASA Quality
programs:
• NCQA/AHA/ASA Heart and Stroke Recognition Program
• Disease Specific Care Certification for Primary Stroke
Centers (The Joint Commission/AHA/ASA)
• Advanced Certification in Heart Failure (TJC/AHA)
65
GWTG Cumulative Progress through
September 8, 2009:
Contracts
Patient
Records
CAD
416
547,512
Heart Failure
431
287,826
Stroke
1318
1,006,002
TOTAL
2165
1,978,228
Module
Source: Siebel Dashboards as of 6/30/09
66
Get With The Guidelines:
Elements of Success
•
•
•
•
•
Attend a GWTG workshop
Designate a champion from hospital
Recruit care team for implementation
Enter baseline data into the Patient Management Tool
Institute care paths, standing orders and discharge
protocols that are consistent with the ASA/AHA
guidelines
• Utilize the Patient Management Tool to record and
improve patient care.
• Achieve Performance Award levels
67
How is Health Integration Technology used by
GWTG to achieve goals?
Patient Management ToolTM
• Easy to use, web-based, real-time data management and
decision support tool
• Incorporates proven, decision-support-guideline
reminder checks
• Opportunity for concurrent data collection-access to realtime data collection and report generation to support
rapid CQI
• Automatically generated, patient-specific education
materials customized for the patient
• Core measure reporting options
68
AHA GWTG-HF Web Based
Patient Management Tool
69
Program Progress Reports
70
GWTG-CAD: Performance
Measures
100.0%
90.0%
80.0%
70.0%
Compliance
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
ASA within
24 Hours
ASA at
Discharge
Beta Blockers
at Discharge
ACEI or ARB at D/C for
LVSD
Lipid Lowering
Therapy at D/C
for LDL > 100
Smoking Cessation
Counseling
Baseline
82.1%
83.3%
77.9%
68.8%
72.1%
62.6%
76.9%
56.1%
Current
91.5%
94.2%
94.1%
92.6%
91.6%
98.4%
92.7%
85.8%
Composite
100%
Performance Measure Compliance Measure
Performance Measure
Baseline = Admissions Jan2002 – Dec2002
Current = Admissions Jul2008-Jun2009
July 2009
71
GWTG-HF: Performance Measures
100.0%
90.0%
80.0%
Compliance
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
Discharge Instructions
LV Function
Measurement
ACEI or ARB at
D/C for LVSD
Beta Blocker at
D/C for LVSD
Smoking Cessation
Counseling
Composite Performance
Measure
100% Compliance
Measure
Baseline
69.7%
90.1%
81.2%
87.3%
77.4%
80.1%
60.1%
Current
89.5%
96.7%
91.8%
92.5%
96.1%
92.5%
83.8%
Performance Measure
Baseline = Admissions Jan2005 – Dec2005
Current = Admissions Jul2008 – Jun2009
July 2009
72
GWTG-Stroke: Performance
Measures
100.0%
90.0%
80.0%
Compliance
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
tPA < 3hr with
Arrival < 2hr after
Onset
Early
Antithrombotic
DVT Risk
Management
Antithrombotic Tx
Lipid Lowering
Anticoag. Tx at
at
Therapy at D/C for
Discharge for Afib
Discharge
LDL > 100
Baseline
27.6%
87.9%
65.8%
92.7%
52.9%
Current
67.5%
96.1%
92.8%
97.2%
93.6%
Smoking
Cessation
Counseling
Composite
Performance
Measure
100% Compliance
Measure
39.7%
44.3%
70.5%
40.2%
84.0%
95.3%
92.3%
83.0%
Performance Measure
Baseline = Admissions Jan2003 – Dec2003
Current = Admissions Jul2008 – Jun2009
July 2009
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GWTG Publications
2009 through 8/2/09:
13 Published Manuscripts (4 HF, 5 CAD, 3 Stroke, 1 CAD/HF)
23 Abstracts presented at Conferences
(ISC – 10, ACC – 6, QCOR – 7, HFSA – 0)
Snapshot of GWTG papers in process:
23 Manuscripts: 12 pending Journal decision, 11 in process to Journal
submission
18 Abstracts: 8 pending acceptance at AHA 2009 conference, 10 in process to
manuscript
32 Total Research Proposals in Queue
2008 Results:
20 Published Manuscripts (5 HF, 10 CAD, 5 Stroke)
2007 Results:
4 Published Manuscripts (1 HF, 3 CAD)
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Future Impact: Advancing Healthcare
• Largest national hospital-based program dedicated
to quality of care improvement for patients with CVD
• Participating hospitals have demonstrated greater
adherence to national guideline-recommended
therapies compared to other US hospitals publicly
reporting data at the same time (proven framework)
• With the possibility of such dramatic outcomes,
helping healthcare professionals implement
guidelines presents a great opportunity to improve
the health of patients now and in the future.
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Hvala - Thank you!
For more
information
contact the UCI
Heart Disease
Prevention
Program at:
www.heart.uci.edu
949-824-5561
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