JACC: Performance measure compliance rates vary in cardiac outpatients

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Researchers have found variable compliance with performance measures in outpatient settings for patients with coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF), according to a study published in the June 29 edition of the Journal of the American College of Cardiology.

Paul S. Chan, MD, from the Mid America Heart Institute in Kansas City, Mo., and colleagues from various facilities examined data from the American College of Cardiology’s PINNACLE program from July 1, 2008, through June 30, 2009. Of the more than 14,000 patients enrolled from 27 U.S. practices, 56 percent had CAD, 34 percent had HF and 19 percent had nonvalvular AF.

Researchers found that compliance with performance measures ranged from being very low (e.g., 13 percent of CAD patients screened for diabetes mellitus and 18 percent referred for cardiac rehabilitation after MI or CABG surgery) to very high (e.g., 96 percent of HF patients with blood pressure assessments), with moderate (70 to 90 percent) compliance observed for most performance measures.

Regarding patients with CAD, moderate compliance was seen for adherence to beta-blocker therapy after MI (86 percent), ACE-I/ARB therapy in patients with concurrent left ventricular systolic dysfunction or diabetes (72 percent), use of antiplatelet therapy (84 percent) and annual lipid profile assessment (74 percent).

Researchers also determined that use of thienopyridine therapy within 12 months of receiving a drug-eluting stent—a Class I recommendation—was 81 percent.

Compliance rates for HF performance measures ranged from being very high for weight assessment (96 percent) and for beta-blocker therapy in patients with LV systolic dysfunction (93 percent), to very poor for HF patient education (43 percent) and assessment of HF clinical signs on examination (23 percent), according to the study.

Moderate compliance was found with ACE-I/ARB in patients with LV systolic dysfunction (85 percent), warfarin for patients with concurrent AF (80 percent) and clinical symptom assessment (88 percent).

For AF, researchers found a 73 percent compliance rate for assessment of thromboembolic risk, which did not differ among those younger or older than 75 years of age. Warfarin was appropriately used for stroke prophylaxis in nearly four out of five patients with a CHADS2 score of 2 or greater, and the rate was similar for those younger and older than 75 years of age.

However, among patients taking warfarin, researchers were unable to adequately assess patients’ compliance with monthly monitoring of anticoagulation levels.
 
There were no statistically significant differences in performance measures compliance rates by race or sex.

In an accompanying editorial, Sunil V. Rao, MD, from Duke Clinical Research Institute in Durham, N.C., wrote: “While these data are interesting and important, the publication of the PINNACLE data has greater implications for the future of quality improvement. This paper represents a ‘first look’ at the data from only 27 cardiology practices that chose to participate in the PINNACLE program. Therefore, an important message of this paper is the potential that this registry represents part of a portfolio of quality improvement programs that span the continuum of care from the inpatient to the outpatient setting.”