TY - JOUR
T1 - Variations in coronary artery disease secondary prevention prescriptions among outpatient cardiology practices
T2 - Insights from the NCDR (National Cardiovascular Data Registry)
AU - Maddox, Thomas M.
AU - Chan, Paul S.
AU - Spertus, John A.
AU - Tang, Fengming
AU - Jones, Phil
AU - Ho, P. Michael
AU - Bradley, Steven M.
AU - Tsai, Thomas T.
AU - Bhatt, Deepak L.
AU - Peterson, Pamela N.
N1 - Funding Information:
This research was supported by American College of Cardiology Foundation’s National Cardiovascular Data Registry (NCDR) . PINNACLE registry is an initiative of the American College of Cardiology Foundation. Bristol-Myers Squibb and Pfizer Inc. are founding sponsors of the PINNACLE registry. The views expressed in the manuscript represent those of the authors and do not necessarily represent the official views of the NCDR or its associated professional societies. They also do not necessarily represent the official views of the U.S. Department of Veterans Affairs. Drs. Maddox and Bradley are supported by Career Development Award grants from the U.S. Department of Veterans Affairs Health Services Research and Development division . Dr. Chan is supported by Career Development Grant Award K23HL102224 from National Institutes of Health (NIH) , National Heart, Lung, and Blood Institute . Dr. Peterson is supported by Agency for Healthcare Research and Quality grant K08 HS019814-01 . Dr. Spertus contracted with American College of Cardiology Foundation to analyze the PINNACLE (Practice Innovation and Clinical Excellence) registry; he receives grant support from the NIH, American Heart Association, Lilly, Genentech, and EvaHeart; and he has consulted for United Healthcare, St. Jude Medical, Amgen, and Genentech. Dr. Bhatt serves on the advisory board of Medscape Cardiology, and boards of directors of Boston VA Research Institute and Society of Chest Pain Centers; he is Chair, American Heart Association Get With The Guidelines Science Subcommittee; receives honoraria from American College of Cardiology (as editor, Clinical Trials, Cardiosource), Duke Clinical Research Institute (clinical trial steering committees), Slack Publications (as chief medical editor, Cardiology Today Intervention), WebMD (CME steering committees, and as senior associate editor, Journal of Invasive Cardiology); and he has received research grants from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Sanofi Aventis, and The Medicines Company , and unfunded research for FlowCo, PLx Pharma, and Takeda . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/2/18
Y1 - 2014/2/18
N2 - Objectives This study assessed practice variations in secondary prevention medication prescriptions among coronary artery disease (CAD) patients treated in outpatient practices participating in the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) registry. Background Among patients with CAD, secondary prevention with a combination of beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins reduces cardiac mortality and myocardial infarction (MI). Accordingly, every CAD patient should receive the combination of these medications for which they are eligible. However, little is known about current prescription patterns of these medications and the variation in use among outpatient cardiology clinics. Methods Using data from NCDR PINNACLE registry, a national outpatient cardiology practice registry, we assessed medication prescription patterns among eligible CAD patients, between July 2008 and December 2010. Overall rates of prescription and variation by practice were calculated, adjusting for patient characteristics. Results Among 156,145 CAD patients in 58 practices, 103,830 (66.5%) patients were prescribed the optimal combination of medications for which they were eligible. The median rate of optimal combined prescription by practice was 73.5% and varied from 28.8% to 100%. After adjustment for patient factors, the practice median rate ratio for prescription was 1.25 (95% confidence interval: 1.20 to 1.32), indicating a 25% likelihood that 2 random practices would differ in treating identical CAD patients. Conclusions Among a national registry of CAD patients treated in outpatient cardiology practices, over one-third of patients failed to receive their optimal combination of secondary prevention medications. Significant variation was observed across practices, even after adjusting for patient characteristics, suggesting that quality improvement efforts may be needed to support more uniform practice.
AB - Objectives This study assessed practice variations in secondary prevention medication prescriptions among coronary artery disease (CAD) patients treated in outpatient practices participating in the National Cardiovascular Data Registry (NCDR) Practice Innovation and Clinical Excellence (PINNACLE) registry. Background Among patients with CAD, secondary prevention with a combination of beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins reduces cardiac mortality and myocardial infarction (MI). Accordingly, every CAD patient should receive the combination of these medications for which they are eligible. However, little is known about current prescription patterns of these medications and the variation in use among outpatient cardiology clinics. Methods Using data from NCDR PINNACLE registry, a national outpatient cardiology practice registry, we assessed medication prescription patterns among eligible CAD patients, between July 2008 and December 2010. Overall rates of prescription and variation by practice were calculated, adjusting for patient characteristics. Results Among 156,145 CAD patients in 58 practices, 103,830 (66.5%) patients were prescribed the optimal combination of medications for which they were eligible. The median rate of optimal combined prescription by practice was 73.5% and varied from 28.8% to 100%. After adjustment for patient factors, the practice median rate ratio for prescription was 1.25 (95% confidence interval: 1.20 to 1.32), indicating a 25% likelihood that 2 random practices would differ in treating identical CAD patients. Conclusions Among a national registry of CAD patients treated in outpatient cardiology practices, over one-third of patients failed to receive their optimal combination of secondary prevention medications. Significant variation was observed across practices, even after adjusting for patient characteristics, suggesting that quality improvement efforts may be needed to support more uniform practice.
KW - CAD
KW - outpatient practice
KW - secondary prevention
UR - http://www.scopus.com/inward/record.url?scp=84893823410&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2013.09.053
DO - 10.1016/j.jacc.2013.09.053
M3 - Article
C2 - 24184238
AN - SCOPUS:84893823410
VL - 63
SP - 539
EP - 546
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 6
ER -