Cath Lab Digest

"Predictors of Survival in Patients Undergoing Rescue PCI”

“Door-to-Balloon Time Trends in STEMI Patients Transferred for PCI”

So much research is happening today in cardiology. Who is doing the research, and where are the patients coming from?

There are many hospitals nationwide participating in research as a part of the National Cardiovascular Data Registry (NCDR^®). The NCDR is operated by the American College of Cardiology (ACC), in partnership with leading cardiovascular associations dedicated to compiling data and using it to create and implement protocols that improve care for patients nationwide. The CathPCI Registry^®, a partnership between ACC and the Society for Coronary Angiography and Interventions (SCAI), was launched in 1997 as a rigorous method for collecting and analyzing clinical cardiovascular data. Inclusion criteria for the CathPCI Registry include consecutive patients who receive diagnostic cardiac catheterization and/or percutaneous coronary intervention (PCI). The program’s primary goals are to support local quality improvement and to create a place where healthcare providers can find support as they respond to increasing requirements for documentation of processes and outcomes. Today, the NCDR has expanded to include six registries: 5 hospital-based and one practice-based, as follows:

• ACTION Registry^®-GWTG™ for high-risk ST-elevation myocardial infarction (STEMI)/non-STEMI (NSTEMI) patients
• CARE Registry^® for carotid artery stenting and endarterectomy procedures
• CathPCI Registry^® for cardiac catheterization and PCI procedures
• ICD Registry™ for tracking implantable cardioverter defibrillator procedures
• IMPACT Registry™ for adult and pediatric congenital heart conditions (coming soon)
• PINNACLE Registry^®, a practice-based registry.

As the NCDR moves forward, there are plans for peripheral registries, to include the extremities, the aorta, the mesentery and the renal vasculature. All of these registries exist for one reason, as put forward in the NCDR Mission Statement:

“To improve the quality of cardiovascular patient care by providing information, knowledge and tools; implementing quality initiatives; and supporting research that improves patient care and outcomes.”

Each registry begins with data gathering to collect demographics, risk factors and registry-specific data points during and post-procedure until the patient is discharged.  After the patient’s discharge, the form is completed by adding procedure results, any post-procedure complications, and the patient’s disposition. The data is then entered into either a third-party vendor or directly into the NCDR’s website (www.ncdr.com). Each quarter, the data is submitted to the NCDR for their analysis. The NCDR uses the data from the previous 4 quarters for their analysis, on a “rolling 4 quarters” (R4Q) basis. As a new quarter is added, the oldest quarter is dropped. The official NCDR report is released within approximately two weeks following the submission deadline. 

The report is an in-depth document that consists of an executive summary and a detail section. Included in the executive summary are metrics that are either endorsed by NQF (National Quality Forum) or are felt to be notable to hospital executives. These metrics are listed by your hospital’s results, which are compared to all hospitals on the rolling 4 quarters. Following the executive summary is the detail section, expanding the metrics and providing information about each of the data elements collected. The detail section includes the denominator (how many patients are included in this element overall) and the numerator (how many patients met the qualifications in the element). For each element, it is possible to analyze the data and find where your hospital is falling short in comparison to national experience. By evaluating each metric and using the NCDR-assigned patient ID number, it is then possible to investigate each metric and find where problems exist, as well as to discover whether the issue lies in data collection, data entry or is actually reflective of the activities in the lab. 

When a hospital is first beginning with a registry, the greatest challenge usually lies in the data collection and entry. Data gathering begins in the cath lab. Anyone who has worked in a cath lab knows how hectic it can be during a procedure, and especially during an emergency. Many data elements are skipped or omitted. It is important, however, that the lab staff correctly identify the data that can’t be found anywhere else: the in-room time, start and finish time, equipment, inflation times, and procedure medications. Having a software package that communicates with the hemodynamic software eliminates many of those problems by requiring the staff to enter the data only one time rather than on the monitor and then again on the paper form. The software also transmits the demographic data, eliminating translation errors in spelling and numbers.