Version 2.2 Institutional Outcomes Report 2012Q2 If User desires to publish or otherwise distribute or use, in whole or in part, any aggregate data or reports provided by ACCF, or produced in connection with or derived from NCDR, with the exception of strictly internal use within User's organization, User must first obtain the prior express written consent of ACCF. To the extent User is permitted to publish aggregate data, such aggregate data and any related information published in connection with it must be reviewed and approved by ACCF prior to publication. National Cardiovascular Data Registry ACTION Registry -GWTG 800-257-4737 www.ncdr.com ncdr@acc.org 1
Table of Contents Inclusion Summary 3 Quarters included in this report: 3 group included in this report: 3 Release Notes: 3 Frequently used terminology: 4 Executive Summary 7 Section IA: Composite Measures 7 Section IIA: AMI Performance Measures 10 Section III: Quality Metrics 14 Section IV: Participant Graphs 16 Detail Section Line Reference 21 2
Inclusion Summary Quarters included in this report: Timeframe Benchmark Inclusion Status Submission Type All Patients STEMI NSTEMI Included in Executive Summary 2011Q3 Limited 32 9 23 Yes 2011Q4 Limited 53 11 42 Yes 2012Q1 Limited 63 26 37 Yes 2012Q2 Limited 59 30 29 Yes group included in this report: Group Group Name 2 No Cath Lab Services on-site, or only Diagnostic Catheterizations Number of Hospitals per Group 3 Diagnostic Caths and PCIs performed on-site 111 4 Cardiac Surgery, to include Diagnostic Caths and PCIs, are performed on-site (Region 1) 5 Cardiac Surgery, to include Diagnostic Caths and PCIs, are performed on-site (Region 2) 6 Cardiac Surgery, to include Diagnostic Caths and PCIs, are performed on-site (Region 3) 7 Cardiac Surgery, to include Diagnostic Caths and PCIs, are performed on-site (Region 4) 18 36 213 148 Your Hospital's Group 59 X Release Notes: ACTION Registry -GWTG Outcomes Report Release Notes for 2012 Q2 Report Changes: 1. Quality Metric 24, Detail Line 1027 - The earliest date for all anticoagulants will be checked. Previously if UFH was outside of the first 24 hours it would exclude the record even if another anticoagulant was within the 24 hours. 2. Quality Metric 31, Detail Line 1034 - The algorithm was changed to exclude patients with an LDL "Value Out of Range" selected. 3. Quality Metric 25, Detail Lines 1028, 1197, 1568, and 1925 - The algorithm was changed to not evaluate Primary PCI for NSTEMI records. 4. Detail Lines 1375, 1741, 2056 - An additional line was added to include the proportion of non-cabg related transfusions. 5. Detail Lines 1609 and 1610 - No reason documented was removed from the algorithm for both Reason Thrombolytics not Administered and Reason Primary PCI not Performed. 6. Detail Lines 1376, 1742 and 2057 - The denominator now includes only those patients that received a red blood cell infusion instead of those that had a red blood infusion and a CABG related transfusion. 7. Detail Lines 1264, 1268, 1272 and 1276 - There is no check in the data collection tool to verify that if First ECG Obtained is Pre-Hospital or After 1st Hospital Arrival that the First ECG Date/Time is prior to or after Arrival Date/Time. If first ECG obtained pre hospital is selected however the First ECG Date/Time is after the Arrival Date/Time a negative number will be calculated. This can be corrected by changing the First ECG obtained to After 1st hospital arrival or changing First ECG Date/Time prior to Arrival Date/Time. 3
Inclusion Summary Frequently used terminology: (Rolling Four Quarters) Benchmark Inclusion Status The four (4) consecutive quarters included in this report. (Example: The 2011Q1 report includes 2010Q2, 2010Q3, 2010Q4 and 2011Q1. The Q in indicates the last quarter of the rolling four quarters). Indicates whether a submission will be included in the aggregated data (benchmark) and comparison group statistics. Green, Yellow and Red stoplights denote the status. A Green status indicates the submission (one quarter/timeframe) is included in the benchmark and comparison group statistics. The data has successfully passed all data assessment and completeness checks. A Yellow status indicates the submission (one quarter/timeframe) is not included in the benchmark and comparison group statistics. Data is displayed in the quarterly column, but is not included in the My Hospital summary. The data has not passed the overall completeness assessment checks. A Red status indicates the submission (one quarter/timeframe) is not included in the benchmark or comparison group statistics. Data is not displayed in the quarterly column. A null or blank status indicates no submission has been received for that quarter/timeframe. Data is not displayed in the quarterly column. Submission Type My Hospital Hospital 50th Pctl Hospital 90th Pctl Registry Pts Group 2 Indicates the Submission Type selected at the time of data export/submission. Limited submissions refer to the ACTION Registry GWTG Limited dataset. Premier submissions refer to the full ACTION dataset. The values for a metric/measure (over ) of data submitted by your facility with a Benchmark Inclusion Status of Green. The median (or midpoint or 50th percentile) of all participants aggregated data for the metric or measure. Half of all participants will be above the median, and half will be below. This value will correspond to the midpoint of the box/whisker plot with a Benchmark Inclusion Status of Green. The 90th percentile of all participants aggregated data for the metric or measure. 10% of all participants will be above the 90th percentile value, and 90% will be below. This value will correspond to the right-most endpoint of the box/whisker plot with a Benchmark Inclusion Status of Green. The aggregated value for the measure/metric across all patients (over ). To be included, data must have a Benchmark Inclusion Status of Green. ACTION-GWTG sites with same on-site cardiac facilities (cath lab and open-heart surgery) as your hospital, based on AHA-reported data. No Cardiac Services are performed at your facility, or only Diagnostic Catheterizations (No PCIs, or open-heart surgeries). Participants: Compared against all Participants where no cath lab services or Diagnostic cath (only) services are performed on-site. International Participants: Compared against all Participants where no cath lab services or Diagnostic cath (only) services are performed on-site. Indicator X is a representation of where your hospital would fall in the distribution. Group 3 Diagnostic Cath and PCIs performed on site. Adult Cardiac Interventions and diagnostic catheterizations are performed at your facility, but not open-heart surgery. Participants: Compared against all Participants where Diagnostic Cath and PCIs are performed on site. 4
Inclusion Summary International Participants: Compared against all Participants where Diagnostic Cath and PCIs are performed on site. Indicator X is a representation of where your hospital would fall in the distribution. Group 4 Diagnostic Cath, PCIs and Cardiac Surgery performed on site. All cardiac procedures are performed at your facility, to include diagnostic catheterizations, PCIs, and open-heart surgery. Participants: Compared against (Region 1) Participants where Diagnostic Cath, PCIs and Cardiac Surgery are performed on site. Region 1 includes facilities in Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, Pennsylvania, and New Jersey. International Participants: Compared against all participants (not Region specific) where Diagnostic Cath, PCIs and Cardiac Surgery are performed on site. Indicator X in box-whisker is a representation of where your hospital would fall in the distribution. Group 5 Diagnostic Cath, PCIs and Cardiac Surgery performed on site. All cardiac procedures are performed at your facility, to include diagnostic catheterizations, PCIs, and open-heart surgery. Participants: Compared against (Region 2) Participants where Diagnostic Cath, PCIs and Cardiac Surgeries are performed on site. Region 2 includes facilities in Delaware, Maryland, District of Columbia, Virginia, West Virginia, North Carolina, South Carolina, Georgia, Florida, Kentucky, Mississippi, Alabama, Oklahoma, Texas, Arkansas, and Louisiana. International Participants: Group 4 is not applicable. Group 6 Diagnostic Cath, PCIs and Cardiac Surgery performed on site. All cardiac procedures are performed at your facility, to include diagnostic catheterizations, PCIs, and open-heart surgery. Participants: Compared against (Region 3) Participants where Diagnostic Cath, PCIs and Cardiac Surgeries are performed on site. Region 3 includes facilities in Wisconsin, Michigan, Illinois, Indiana, Ohio, Missouri, North Dakota, South Dakota, Nebraska, Kansas, Minnesota, and Iowa International Participants: Group 5 is not applicable. Group 7 Diagnostic Cath, PCIs and Cardiac Surgery performed on site. All cardiac procedures are performed at your facility, to include diagnostic catheterizations, PCIs, and open-heart surgery. Participants: Compared against (Region 4) Participants where Diagnostic Cath, PCIs and Cardiac Surgeries are performed on site. Region 4 includes facilities in Idaho, Montana, Wyoming, Nevada, Utah, Colorado, Arizona, New Mexico, Alaska, Washington, Oregon, California, and Hawaii. International Participants: Group 6 is not applicable. Note: Where a facility is not included in any of the comparison groups, due to an unmatchable AHA number,no X will be displayed in the Your Hospital's Group column. 5
Inclusion Summary Box and Whisker Plots 6
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section IA: Composite Measures STEMI/NSTEMI Composite Measures 1 Overall AMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 94.3% 94.8% 98.9% Includes all 11 acute and discharge performance measures. Proportion of performance measure opportunities that were met among eligible opportunities. Distribution of Hospital Performance 10th percentile 90th percentile Better Measures include: Aspirin at Arrival Evaluation of LV Systolic Function Reperfusion Therapy (STEMI only) Time to Fibrinolytics (STEMI only) Time to Primary PCI (STEMI only) Aspirin at Discharge Beta Blocker at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral [Detail Line:1002] 2 Overall defect free care My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 69.7% 73.8% 93.5% The proportion of patients that receive "perfect care" based upon their eligibility for each performance measure. If a patient fails to receive even one therapy for which he or she is eligible, that patient fails to meet the "defect-free" criteria and will be removed from the numerator. That patient will still be included in the denominator however. [Detail Line:1003] 3 STEMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 96.6% 96.7% 99.6% Includes all 11 acute and discharge performance measures for STEMI patients. Proportion of performance measure opportunities that were met among eligible opportunities. Measures include: Aspirin at Arrival Evaluation of LV Systolic Function Reperfusion Therapy (STEMI only) Time to Fibrinolytics (STEMI only) Time to Primary PCI (STEMI only) Aspirin at Discharge Beta Blocker at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral [Detail Line:1004] 4 NSTEMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 92.3% 93.6% 98.7% Includes all 8 acute and discharge performance measures for NSTEMI patients. Proportion of performance measure opportunities that were met among eligible opporutnities. Measures include: Aspirin at Arrival Evaluation of LV Systolic Function Aspirin at Discharge Beta Blocker at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral [Detail Line:1005] 7
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section IA: Composite Measures 5 Acute AMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 97.9% 96.4% 99.3% Includes all 5 acute composite performance measures for all AMI patients. Proportion of AMI patients with perfect adherence to the performance measures among all eligible care opportunities for those patients. Measures include: Aspirin at Arrival Evaluation of LV Systolic Function Reperfusion Therapy (STEMI only) Time to Fibrinolytics (STEMI only) Time to Primary PCI (STEMI only) [Detail Line:1006] 6 Discharge AMI performance composite My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 91.8% 94.3% 99.2% Includes all 6 discharge performance measures for all AMI patients. Proportion of performance measure opportunities that were met among eligible opporutnities. Measures include: Aspirin at Discharge Beta Blocker at Discharge ACE-I or ARB for LVSD at Discharge Statin at Discharge Adult Smoking Cessation Advice Cardiac Rehab Referral [Detail Line:1007] 8
Section IB: Composite Measures Graphs Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Overall AMI Performance Composite: 2011Q3-2012Q2 Overall Defect Free Care: 2011Q3-2012Q2 100.0% 98.0% My Hospital Group Hospitals 90th = 99% 100.0% 90.0% My Hospital Group Hospitals 90th = 93% 96.0% 80.0% 94.0% 70.0% 92.0% 60.0% 90.0% 50.0% 88.0% 40.0% 86.0% 30.0% Hospital Score 87.6% 93.4% 94.7% 98.5% Hospital Score 35.5% 61.7% 73.2% 92.6% STEMI Performance Composite: 2011Q3-2012Q2 NSTEMI Performance Composite: 2011Q3-2012Q2 100.0% 98.0% My Hospital Group Hospitals 90th = 100% 100.0% 98.0% My Hospital Group Hospitals 90th = 99% 96.0% 96.0% 94.0% 94.0% 92.0% 92.0% 90.0% 90.0% 88.0% 88.0% 86.0% Hospital Score 89.3% 96.5% 97.6% 98.5% Hospital Score 86.5% 92.1% 92.1% 98.5% Acute AMI Performance Composite: 2011Q3-2012Q2 Discharge AMI Performance Composite: 2011Q3-2012Q2 100.0% 99.0% My Hospital Group Hospitals 90th = 99% 100.0% 98.0% My Hospital Group Hospitals 90th = 99% 98.0% 96.0% 97.0% 94.0% 92.0% 96.0% 90.0% 95.0% 88.0% 94.0% 86.0% 93.0% 84.0% Hospital Score 93.2% 97.3% 99.3% 99.3% Hospital Score 84.2% 90.9% 91.6% 97.9% 9
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section IIA: AMI Performance Measures Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, Ho PM, Kosiborod MN, Masoudi FM, Nallamothu BK. ACC/AHA 2008 performance measures for adults with ST-elevation and non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2008;52:2046 99 STEMI/NSTEMI Performance Measures 7 Aspirin at arrival My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 97% 99.3% 100.0% Proportion of patients prescribed aspirin at arrival excluding patients transferred in and out. [Detail Line:1009] Distribution of Hospital Performance 10th percentile 90th percentile Better 8 Aspirin prescribed at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 99.3% 99.1% 100.0% Proportion of patients prescribed aspirin at discharge. [Detail Line:1010] 9 Beta-blocker prescribed at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 99.4% 97.9% 100.0% Proportion of patients prescribed a beta-blocker at discharge. [Detail Line: 1011] 10 Statin prescribed at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 100% 99.1% 100.0% Proportion of patients prescribed a statin at discharge. [Detail Line:1012] 11 Evaluation of LV systolic function My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 99.4% 96.1% 100.0% Proportion of patients evaluated for LV systolic function. [Detail Line:1013] 12 ACE-I or ARB for LVSD at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 85% 91.8% 100.0% Proportion of patients prescribed an ACE-I or ARB for LVSD at discharge. [Detail Line:1014] 13 Proportion of STEMI patients receiving fibrinolytics within 30 minutes My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 23.8% 100.0% Proportion of STEMI patients with a time from your hospital arrival (or subsequent ECG if ST elevation first noted on subsequent ECG) to fibrinolytics <= 30 minutes. [Detail Line:1015] 14 Median time in minutes to fibrinolytic therapy for STEMI patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 36.5 15.6 Your hospital's median time in minutes from hospital arrival to fibrinolytics for STEMI patients. [Detail Line:1016] 10
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section IIA: AMI Performance Measures Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, Ho PM, Kosiborod MN, Masoudi FM, Nallamothu BK. ACC/AHA 2008 performance measures for adults with ST-elevation and non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2008;52:2046 99 15 Proportion of STEMI patients receiving primary PCI within 90 minutes My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 93.7% 96.1% 100.0% Proportion of STEMI patients with a time from your hospital arrival (or subsequent ECG if ST elevation first noted on subsequent ECG) to primary PCI <= 90 minutes. [Detail Line:1017] 16 Median Time in minutes to primary PCI for STEMI patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 61 60.0 48.5 Your hospital's median time in minutes from hospital arrival to primary PCI for STEMI patients. [Detail Line:1018] 17 Reperfusion therapy My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 100% 98.8% 100.0% Proportion of STEMI patients that received either fibrinolytics or a primary PCI. [Detail Line:1019] 18 Time in minutes from ED arrival at STEMI referral facility to ED discharge from STEMI referral facility in patients transferred for PCI (1) My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 35 47.2 29.6 Your hospital's median time in minutes from ED arrival at referral facility to ED discharge at referral facility among patients transferred for a primary PCI. [Detail Line:1020] Low Volume Alert 19 Time in minutes from ED arrival at STEMI referral facility to Primary PCI at STEMI receiving facility among transferred patients (1) My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 76.5 108.3 81.8 Your hospital's median time in minutes from arrival at STEMI referring facility to primary PCI at STEMI receiving facility among patients transferred for a primary PCI. [Detail Line:1021] Low Volume Alert 20 Adult smoking cessation advice counseling My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 100% 100.0% 100.0% Proportion of patients that received smoking cessation advice/counseling among those that have smoked within the past year. [Detail Line:1022] 21 Cardiac rehabilitation patient referral from an inpatient setting My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 67.1% 84.1% 99.2% Proportion of patients that received a cardiac rehab referral. [Detail Line: 1023] Executive Summary Footnotes 1 IMPORTANT INTERPRETATION NOTE: Median times by quarter are plotted in the graph, thus downward slope indicates improvement as shorter times are preferable 11
Section IIB: AMI Performance Measures Graphs Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Aspirin at Arrival: 2011Q3-2012Q2 Aspirin at Discharge: 2011Q3-2012Q2 100.0% 98.0% My Hospital Group Hospitals 90th = 100% 100.0% 99.5% My Hospital Group Hospitals 90th = 100% 99.0% 96.0% 98.5% 94.0% 98.0% 92.0% 97.5% 97.0% 90.0% 96.5% 88.0% 96.0% Hospital Score 89.7% 97.9% 97.9% 100.0% Hospital Score 96.4% 100.0% 100.0% 100.0% Beta Blocker at Discharge: 2011Q3-2012Q2 Statin at Discharge: 2011Q3-2012Q2 100.0% 99.5% 99.0% My Hospital Group Hospitals 90th = 100% 100.0% 98.0% My Hospital Group Hospitals 90th = 100% 98.5% 96.0% 98.0% 97.5% 94.0% 97.0% 92.0% 96.5% 96.0% 90.0% Hospital Score 96.4% 100.0% 100.0% 100.0% Hospital Score 100.0% 100.0% 100.0% 100.0% Evaluation of LV Systolic Function: 2011Q3-2012Q2 ACE-I or ARB for LVSD at Discharge: 2011Q3-2012Q2 100.0% 99.0% My Hospital Group Hospitals 90th = 100% 100.0% 96.0% My Hospital Group Hospitals 90th = 100% 92.0% 98.0% 88.0% 97.0% 84.0% 96.0% 80.0% 95.0% 76.0% Hospital Score 100.0% 97.7% 100.0% 100.0% Hospital Score 100.0% 85.7% 77.8% 100.0% 12
Section IIB: AMI Performance Measures Graphs Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Time to Fibrinolytics <= 30 mins (STEMI): 2011Q3-2012Q2 Time to Primary PCI <= 90 mins (STEMI): 2011Q3-2012Q2 100.0% 90.0% 80.0% My Hospital Group Hospitals 90th = 100% 100.0% 96.0% 92.0% My Hospital Group Hospitals 90th = 100% 70.0% 60.0% 88.0% 84.0% 80.0% 50.0% 76.0% 40.0% 72.0% 30.0% 68.0% Hospital Score Hospital Score 71.4% 90.9% 100.0% 96.0% Reperfusion Therapy (STEMI): 2011Q3-2012Q2 Door in to Door Out (STEMI): 2011Q3-2012Q2 100.0% 98.0% 96.0% 94.0% 92.0% My Hospital Group Hospitals 90th = 100% Median Time in Mins 64 60 56 52 48 44 40 36 32 My Hospital Group Hospitals 90th = 29.6 28 90.0% 24 Hospital Score 100.0% 100.0% 100.0% 100.0% Hospital Score 60 33.5 Door in to PCI (STEMI): 2011Q3-2012Q2 Adult Smoking Cessation Advice: 2011Q3-2012Q2 Median Time in Mins 115 110 105 100 95 90 85 80 My Hospital Group Hospitals 90th = 81.8 100.0% 98.0% 96.0% 94.0% 92.0% My Hospital Group Hospitals 90th = 100% 75 70 90.0% Hospital Score 102.5 76 Hospital Score 100.0% 100.0% 100.0% 100.0% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% Hospital Score Cardiac Rehab. Referral: 2011Q3-2012Q2 37.9% 65.1% 65.9% 90.5% My Hospital Group Hospitals 90th = 99% 13
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Section III: Quality Metrics Quality Metrics 22 Door to 1st ECG in minutes My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 64.1% 65.0% 83.9% Proportion of AMI patients that received an ECG within 10 minute of arrival at participating hospital. [Detail Line:1025] Distribution of Hospital Performance 10th percentile 90th percentile Better 23 Acute ADP receptor inhibitor therapy among STEMI patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 100% 94.8% 100.0% Proportion of STEMI patients prescribed ADP Receptor Inhibitors 24 hours prior to or after 1st hospital arrival. [Detail Line:1026] 24 Acute anticoagulant agent for NSTEMI My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 94.2% 100.0% Proportion of NSTEMI patients prescribed unfractionated heparin, enoxaparin, bivalirudin or fondaparinux 24 hours prior to or after 1st hospital arrival. [Detail Line:1027] 25 Excessive initial unfractionated heparin (UFH) dose My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 61.7% 12.8% Proportion of AMI patients that received: -An initial bolus dose of UFH >70 units per kilogram OR -A total initial bolus dose exceeding 4000 units OR -An initial infusion > 15 units per kilogram per hour OR -A total initial infusion >1000 units per hour. [Detail Line:1028] 26 Excessive initial enoxaparin dose My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 9.4% 0.0% Proportion of AMI patients that received an initial dose of subcutaneous Enoxaparin >1.05 mg per kilogram. [Detail Line:1029] 27 Excessive initial GPIIb-IIIa inhibitor therapy My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 6.2% 0.0% Proportion of AMI patients that received GPIIb-IIIa (Full dose of Tirofiban if CrCL <30 cc/min and/or dialysis = yes or full dose of Eptifibatide if CrCL <50 cc//min and /or dialysis = yes) [Detail Line:1030] 28 AMI revascularized patients discharged on ADP receptor inhibitors My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 91.1% 93.5% 100.0% Proportion of AMI revascularized patients prescribed an ADP receptor inhibitor at discharge. [Detail Line:1031] 29 ADP receptor inhibitors prescribed at discharge for medically treated AMI patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 59.1% 55.5% 80.0% Proportion of AMI medically treated patients prescribed an ADP receptor inhibitor at discharge. [Detail Line:1032] 30 Aldosterone blocking agents for LVSD at discharge My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 0% 7.8% 37.8% Proportion of AMI patients prescribed an aldosterone blocking agent at discharge. [Detail Line:1033] 14
Section III: Quality Metrics Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 31 LDL-Cholesterol assessment My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 67.7% 85.0% 95.7% Proportion of patients that had an LDL-Cholesterol assessment. [Detail Line: 1034] 32 Aspirin at arrival for all patients My Hospital Hospitals 50th Pctl Hospitals 90th Pctl 97.8% 99.1% 100.0% Proportion of patients that received an aspirin on arrival. [Detail Line:1035] 15
Section IV: Participant Graphs Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Site Admission Trend Admission Trend 45 STEMI NSTEMI 25,000 STEMI NSTEMI 40 35 20,000 Admissions 30 25 20 Admissions 15,000 10,000 15 10 5,000 5 0 Distribution of Patient Age Distribution of Race and Gender 32.0% 28.0% 29% 26% Hospital 60.0% 50.0% 56% Hospital Percent of Admissions 24.0% 20.0% 16.0% 12.0% 8.0% 4.0% 3% 7% 18% 18% 10% 12% 6% 10% 12% 9% 22% 17% Percent of Admissions 40.0% 30.0% 20.0% 10.0% 43% 17% 9% 28% 29% 11% 6% 0.0% 18-44 45-54 55-64 65-69 70-74 75-79 >= 80 0.0% Male/White Male/Non White Female/White Female/Non White 80.0% 76.0% ECG w/in 10 Minutes of Presentation 75% Hospital Time from Symptom Onset to Hospital Presentation 2.01 Hospital Percent of Admissions 72.0% 68.0% 64.0% 60.0% 56.0% 52.0% 70% 68% 57% 56% 67% 54% 2.00 2.00 2.00 2.00 2.01 2.01 Median Hours Time from Hospital Presentation to ECG 8.00 Hospital 48.0% 44.0% 40.0% 45% Male Female <75 years 75+ years 7.00 6.80 7.20 7.60 8.00 8.40 Median Minutes 16
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Acute Medications (w/in 24h of Hospital Presentation) In-Hospital Procedures 100.0% 97% 98% Hospital 90.0% 80.0% 82% 86% Hospital 80.0% 70.0% 65% 65% Percent of Admissions 60.0% 40.0% 55% 54% 34% Percent of Admissions 60.0% 50.0% 40.0% 30.0% 20.0% 20.0% 10% 10.0% 6% 9% 0.0% Aspirin Clopidogrel GP IIb/IIIa 0.0% Diag Cor Angio PCI CABG Drug Eluting vs Bare Metal Stents Reperfusion Use 75.0% 70.0% 71% 69% Hospital 102.0% 100.0% 100% Hospital 65.0% 98.0% 97% 97% Percent of Admissions 60.0% 55.0% 50.0% 45.0% 40.0% Percent of Admissions 96.0% 94.0% 92.0% 90.0% 88.0% 35.0% 30.0% 29% 32% 86.0% 84.0% 84% 85% 84% 25.0% DES Bare Metal 82.0% Reperfusion Transfers in Non-Transfers in 80.0% 70.0% 60.0% In-Hospital Antithrombin Medications 70% 61% Hospital Percent of Admissions 50.0% 40.0% 30.0% 39% 51% 32% 33% 20.0% 10.0% 0.0% 7% 0% 0% 1% UFH LMWH Fondaparinux DTI Thrombolytics 17
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 First Medical Contact to ECG to Hospital Arrival to Needle (Pre-Hospital ECG) FMC to ECG ECG to arrival Arrival to needle First Medical Contact to Hospital Arrival to ECG to Needle (ECG After Hospital Arrival) FMC to arrival Arrival to ECG ECG to needle 12 17 30 33 0 16 0 10 20 30 40 50 60 Minutes 0 10 20 30 40 50 Minutes First Medical Contact to ECG to Hospital Arrival to Balloon (Pre-Hospital ECG) FMC to ECG ECG to arrival Arrival to balloon First Medical Contact to Hospital Arrival to ECG to Balloon (ECG After Hospital Arrival) FMC to arrival Arrival to ECG ECG to balloon Hospital 4 21 51 Hospital 22 0 60.5 7 22 47 30 2 58 0 10 20 30 40 50 60 70 80 Minutes 0 10 20 30 40 50 60 70 80 90 Minutes 18
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 80.0% 70.0% 60.0% 74% Early Catheterization by Subgroups 74% 70% 67% 64% 74% Hospital Cath Time from Hospital Presentation to Procedure 3.5 Hospital Percent of Admissions 50.0% 40.0% 30.0% PCI 1.4 1.7 20.0% 10.0% CABG 68.5 0.0% 0% 0% 0% 0% 0% 0% Male Female <75 years 75+ years <50 cc/min 50+ cc/min 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 Median Hours 8.0% 7.0% In-hospital Clinical Events 7% Hospital Overall 3.0 3.0 Length of Stay Hospital 6.0% Percent of Admissions 5.0% 4.0% 3.0% 3% 4% Early Cath Any PCI 2.0 3.0 3.0 2.0% 1.0% 0.0% 2% 1% 1% 1% 0% Reinfarction Shock CVA/Stroke Death 10.0 Any CABG 9.0 0.0 2.0 4.0 6.0 8.0 10.0 Median Days 19
Executive Summary ACTION Registry -GWTG compared to Rolling Four Quarters () for Hospitals ending 2012Q2 Bleeding Events Among Subgroups Dosing Errors Percent of Admissions 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 3% 1% 4% 1% 3% 4% 5% 1% 3% Hospital Percent of Admissions 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 48% 12% 7% Hospital 0.0% 0% 0% 0% Male Female <75 years 75+ years <50 cc/min 50+ cc/min 0.0% UFH (AMI) Enox (AMI) GP IIb/IIIa (AMI) Discharge Medications Discharge Medications Percent of Admissions 105.0% 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0% 99% 98% 99% 97% Hospital Percent of Admissions 120.0% 100.0% 80.0% 60.0% 40.0% 76% 73% 85% 89% 100% 99% Hospital 65.0% 60.0% 55.0% 63% 62% Aspirin Clopidogrel Beta Blocker 20.0% 0.0% 0% 11% ACE/ARB Overall ACE/ARB Ideal Statin Other Lipid Lowering 20
Detail Section Line Reference Population Section First Line # Last Line # Executive Summary Detail Lines 1000 1035 All Patients Submission Summary 1036 1043 Demographics and Payors 1044 1078 Medical History/Home Medications 1079 1112 Hospital Presentation 1113 1156 Acute and In-Hospital Medications and Dosing Errors 1157 1202 In-Hospital Procedures 1203 1231 Reperfusion Use 1232 1277 Early Invasive Management 1278 1302 Laboratory Results 1303 1325 In-Hospital Events 1326 1347 Bleeding Events 1348 1376 Discharge Therapies 1377 1413 Length of stay 1414 1419 STEMI Patients Demographics and Payors 1420 1454 Medical History/Home Medications 1455 1488 Hospital Presentation 1489 1527 Acute and In-Hospital Medications and Dosing Errors 1528 1573 In-Hospital Procedures 1574 1602 Reperfusion Use 1603 1647 Early Invasive Management 1648 1668 Laboratory Results 1669 1691 In-Hospital Events 1692 1713 Bleeding Events 1714 1742 Discharge Therapies 1743 1778 NSTEMI Patients Demographics and Payors 1779 1813 Medical History/Home Medications 1814 1847 Hospital Presentation 1848 1884 Acute and In-Hospital Medications and Dosing Errors 1885 1930 In-Hospital Procedures 1931 1959 Reperfusion Use 1960 1962 Early Invasive Management 1963 1983 Laboratory Results 1984 2006 In-Hospital Events 2007 2028 Bleeding Events 2029 2057 Discharge Therapies 2058 2093 Overall AMI Subgroups Acute Therapies by Race 2094 2112 Discharge Therapies by Race 2113 2128 Acute and Discharge Therapies by Gender 2129 2159 Acute and Discharge Therapies by Age 2160 2190 Acute and Discharge Therapies by Transfer Status Acute and Discharge Therapies by Diabetes Status Acute and Discharge Therapies by Creatinine Clearance 2191 2214 2215 2238 2239 2267 21
Executive Summary Detail Lines My Hospital Registry Pts 1000 Executive Summary Detail Lines 1001 Composites 1002 Overall AMI Performance Composite 176 201 87.6 268 287 93.4 323 341 94.7 331 336 98.5 1,098 1,165 94.3 68,670 93.3 702,736 94.4 1003 Overall Defect Free Care 11 31 35.5 29 47 61.7 41 56 73.2 50 54 92.6 131 188 69.7 8,015 66.0 86,385 71.4 1004 STEMI Performance Composite 67 75 89.3 82 85 96.5 160 164 97.6 201 204 98.5 510 528 96.6 32,689 95.4 325,574 95.9 1005 NSTEMI Performance Composite 1006 Acute AMI Performance Composite 1007 Discharge AMI Performance Composite 1008 Performance measures 109 126 86.5 186 202 92.1 163 177 92.1 130 132 98.5 588 637 92.3 35,981 91.6 377,162 93.0 69 74 93.2 108 111 97.3 137 138 99.3 144 145 99.3 458 468 97.9 25,840 96.0 251,838 96.1 107 127 84.3 160 176 90.9 186 203 91.6 187 191 97.9 640 697 91.8 42,830 91.8 450,898 93.4 1009 Aspirin at arrival 26 29 89.7 46 47 97.9 47 48 97.9 45 45 100.0 164 169 97.0 8,084 98.4 77,633 98.2 1010 Aspirin prescribed at discharge 27 28 96.4 40 40 100.0 41 41 100.0 43 43 100.0 151 152 99.3 10,231 98.7 102,172 98.4 1011 Beta-blocker prescribed at discharge 27 28 96.4 39 39 100.0 44 44 100.0 44 44 100.0 154 155 99.4 10,404 97.3 105,866 97.1 1012 Statin prescribed at discharge 28 28 100.0 39 39 100.0 48 48 100.0 45 45 100.0 160 160 100.0 10,529 98.9 105,094 98.6 1013 Evaluation of LV systolic function 1014 ACEI or ARB for LVSD at Discharge 29 29 100.0 42 43 97.7 49 49 100.0 46 46 100.0 166 167 99.4 10,850 94.2 109,338 95.0 3 3 100.0 6 7 85.7 7 9 77.8 1 1 100.0 17 20 85.0 1,333 90.2 16,835 89.3 1015 Time to Fibrinolytic Therapy 4 50.0 79 52.7 1016 Median time to fibrinolytic therapy 31.0 29.5 1017 Time to primary PCI 5 7 71.4 10 11 90.9 20 20 100.0 24 25 96.0 59 63 93.7 2,798 94.5 25,075 94.6 1018 Median time to primary PCI 83.0 65.0 61.5 51.0 61.0 59.0 58.0 1019 Reperfusion therapy 9 9 100.0 10 10 100.0 21 21 100.0 29 29 100.0 69 69 100.0 4,104 97.3 39,713 96.4 1020 Median time to Door in door out transfer in patients (1) 1021 Median time to Door to balloon transfer in patients (1) 1022 Adult smoking cessation advice counseling 1023 Cardiac rehabilitation patient referral from an inpatient setting 1024 Quality metrics 60.0 33.5 35.0 43.0 45.0 102.5 76.0 76.5 101.0 105.0 11 11 100.0 8 8 100.0 17 17 100.0 16 16 100.0 52 52 100.0 3,311 98.2 40,868 98.5 11 29 37.9 28 43 65.1 29 44 65.9 38 42 90.5 106 158 67.1 7,022 69.7 80,063 77.8 1025 Door to 1st ECG 18 25 72.0 20 37 54.1 17 28 60.7 20 27 74.1 75 117 64.1 4,101 64.8 41,719 63.4 1026 Acute ADP receptor inhibitor 9 9 100.0 10 10 100.0 18 18 100.0 22 22 100.0 59 59 100.0 2,987 94.0 26,620 93.2
Executive Summary Detail Lines My Hospital Registry Pts therapy among STEMI patients 1027 Acute anticoagulant agent for NSTEMI 1028 Excessive initial unfractionated heparin (UFH) dose 1029 Excessive initial enoxaparin dose 1030 Excessive initial GPIIb-IIIa inhibitor therapy 1031 AMI revascularized patients discharged on ADP receptor inhibitors 1032 ADP receptor inhibitors prescribed at discharge for medically treated AMI patients 1033 Aldosterone blocking agents for LVSD at discharge 3,235 94.1 34,856 93.0 1,000 49.9 11,373 48.1 192 14.7 1,901 11.5 123 5.5 2,024 7.1 18 18 100.0 27 29 93.1 26 29 89.7 31 36 86.1 102 112 91.1 7,102 89.8 70,178 91.1 8 11 72.7 6 11 54.6 7 15 46.7 5 7 71.4 26 44 59.1 1,295 51.6 14,474 55.6 0 5 0.0 0 3 0.0 0 8 0.0 0 2 0.0 0 18 0.0 183 19.2 1,770 15.2 1034 LDL-cholesterol assessment 19 29 65.5 30 43 69.8 31 49 63.3 33 46 71.7 113 167 67.7 9,187 80.7 94,142 82.8 1035 Aspirin at arrival for all patients 26 28 92.9 45 46 97.8 53 54 98.2 54 54 100.0 178 182 97.8 11,133 98.5 112,336 98.3
All Patients Submission Summary My Hospital Registry Pts 1036 Submission summary 1037 Total # of pt admissions 32 53 63 59 207 13,040 130,124 1038 STEMI 9 32 28.1 11 53 20.8 26 63 41.3 30 59 50.9 76 207 36.7 5,245 40.2 50,604 38.9 1039 NSTEMI 23 32 71.9 42 53 79.3 37 63 58.7 29 59 49.2 131 207 63.3 7,795 59.8 79,520 61.1 1040 Transfers in 0 32 0.0 0 53 0.0 5 63 7.9 6 59 10.2 11 207 5.3 3,480 26.7 37,637 28.9 1041 Not Transferred in 32 32 100.0 53 53 100.0 58 63 92.1 53 59 89.8 196 207 94.7 9,560 73.3 92,487 71.1 1042 Transfers out 1 32 3.1 2 53 3.8 6 63 9.5 8 59 13.6 17 207 8.2 360 2.8 5,533 4.3 1043 Not transferred out 30 32 93.8 45 53 84.9 52 63 82.5 47 59 79.7 174 207 84.1 12,026 92.2 118,785 91.3
All Patients Demographics and Payors My Hospital Registry Pts 1044 Demographics 1045 Sex 1046 Male 15 32 46.9 30 53 56.6 41 63 65.1 40 59 67.8 126 207 60.9 8,645 66.3 84,349 64.8 1047 Female 17 32 53.1 23 53 43.4 22 63 34.9 19 59 32.2 81 207 39.1 4,395 33.7 45,775 35.2 1048 Age at admission 1049 Mean age 65 69 68 65 67 66 65 1050 Median age 67 71 63 64 64 65 64 1051 18-44 2 32 6.3 1 53 1.9 2 63 3.2 2 59 3.4 7 207 3.4 744 5.7 9,155 7.0 1052 45-54 6 32 18.8 12 53 22.6 10 63 15.9 9 59 15.3 37 207 17.9 2,026 15.5 23,530 18.1 1053 55-64 7 32 21.9 9 53 17.0 21 63 33.3 23 59 39.0 60 207 29.0 3,507 26.9 34,413 26.5 1054 65-69 2 32 6.3 3 53 5.7 6 63 9.5 10 59 17.0 21 207 10.1 1,661 12.7 15,979 12.3 1055 70-74 5 32 15.6 3 53 5.7 2 63 3.2 2 59 3.4 12 207 5.8 1,403 10.8 13,330 10.2 1056 75-79 3 32 9.4 9 53 17.0 8 63 12.7 4 59 6.8 24 207 11.6 1,244 9.5 11,660 9.0 1057 >= 80 7 32 21.9 16 53 30.2 14 63 22.2 9 59 15.3 46 207 22.2 2,455 18.8 22,057 17.0 1058 Medicare age ( >= 65) 17 32 53.1 31 53 58.5 30 63 47.6 25 59 42.4 103 207 49.8 6,763 51.9 63,026 48.4 1059 Race 1060 White 27 32 84.4 37 53 69.8 42 63 66.7 42 59 71.2 148 207 71.5 11,400 87.4 110,766 85.1 1061 Black/African American 4 32 12.5 4 53 7.6 13 63 20.6 13 59 22.0 34 207 16.4 477 3.7 15,221 11.7 1062 Asian 1 32 3.1 6 53 11.3 5 63 7.9 4 59 6.8 16 207 7.7 727 5.6 2,466 1.9 1063 American Indian/Alaskan 0 32 0.0 0 53 0.0 1 63 1.6 0 59 0.0 1 207 0.5 118 0.9 754 0.6 1064 Hawaiian/Pacific Islander 0 32 0.0 3 53 5.7 2 63 3.2 0 59 0.0 5 207 2.4 83 0.6 216 0.2 1065 Male/White 13 32 40.6 21 53 39.6 27 63 42.9 29 59 49.2 90 207 43.5 7,577 58.1 72,805 56.0 1066 Male/Non White 2 32 6.3 9 53 17.0 14 63 22.2 11 59 18.6 36 207 17.4 1,068 8.2 11,544 8.9 1067 Female/White 14 32 43.8 16 53 30.2 15 63 23.8 13 59 22.0 58 207 28.0 3,823 29.3 37,961 29.2 1068 Female/Non White 3 32 9.4 7 53 13.2 7 63 11.1 6 59 10.2 23 207 11.1 572 4.4 7,814 6.0 1069 Hispanic or Latino Ethnicity 7 32 21.9 6 53 11.3 8 63 12.7 6 59 10.2 27 207 13.0 1,368 10.6 6,235 4.8 1070 Insurance payors 1071 Private 16 32 50.0 23 53 43.4 32 63 50.8 25 59 42.4 96 207 46.4 7,203 55.2 72,781 55.9 1072 Medicare 18 32 56.3 36 53 67.9 34 63 54.0 32 59 54.2 120 207 58.0 6,468 49.6 65,222 50.1 1073 Medicaid 6 32 18.8 13 53 24.5 10 63 15.9 11 59 18.6 40 207 19.3 1,366 10.5 12,810 9.8 1074 Military 0 32 0.0 4 53 7.6 2 63 3.2 6 59 10.2 12 207 5.8 651 5.0 3,824 2.9 1075 State-specific (non-medicaid) 0 32 0.0 0 53 0.0 3 63 4.8 2 59 3.4 5 207 2.4 432 3.3 1,677 1.3 1076 Indian Health Service 0 32 0.0 0 53 0.0 0 63 0.0 0 59 0.0 0 207 0.0 26 0.2 230 0.2 1077 Non-U.S Insurance 0 32 0.0 0 53 0.0 0 63 0.0 0 59 0.0 0 207 0.0 16 0.1 113 0.1 1078 None 3 32 9.4 2 53 3.8 5 63 7.9 8 59 13.6 18 207 8.7 1,288 9.9 15,643 12.0
All Patients Medical History/Home Medications My Hospital Registry Pts 1079 History and risk factors 1080 Current smoker (< 1 year) 12 32 37.5 9 53 17.0 19 63 30.2 18 59 30.5 58 207 28.0 3,698 28.4 45,443 34.9 1081 Hypertension 27 32 84.4 43 53 81.1 53 63 84.1 52 59 88.1 175 207 84.5 9,264 71.1 96,227 74.0 1082 Dyslipidemia 6,183 60.9 63,788 60.9 1083 Currently on dialysis 3 32 9.4 3 53 5.7 2 63 3.2 6 59 10.2 14 207 6.8 370 2.8 3,421 2.6 1084 Chronic lung disease 1,269 12.5 15,577 14.9 1085 Diabetes mellitus 12 32 37.5 21 52 40.4 19 63 30.2 31 59 52.5 83 206 40.3 4,106 31.5 42,801 32.9 1086 Diabetes therapy: 1087 None 0 12 0.0 0 21 0.0 0 19 0.0 0 31 0.0 0 83 0.0 263 6.4 2,733 6.4 1088 Diet 0 12 0.0 0 21 0.0 0 19 0.0 0 31 0.0 0 83 0.0 265 6.5 2,269 5.3 1089 Oral 0 12 0.0 0 21 0.0 0 19 0.0 0 31 0.0 0 83 0.0 1,419 34.6 16,297 38.1 1090 Insulin 0 12 0.0 0 21 0.0 0 19 0.0 0 31 0.0 0 83 0.0 1,087 26.5 12,763 29.8 1091 Other 0 12 0.0 0 21 0.0 0 19 0.0 0 31 0.0 0 83 0.0 45 1.1 201 0.5 1092 Obesity (BMI >= 30) 3,781 37.5 41,829 40.3 1093 Prior MI 2,498 24.6 26,650 25.5 1094 Prior heart failure 1,140 11.3 13,374 12.8 1095 Prior PCI 2,284 22.5 25,939 24.8 1096 Prior CABG 1,226 12.1 14,554 13.9 1097 Atrial fibrillation or flutter (past 2 weeks) 720 7.1 7,834 7.5 1098 Cerebrovascular disease 0 32 0.0 3 53 5.7 10 63 15.9 5 59 8.5 18 207 8.7 1,440 11.1 15,582 12.0 1099 Prior stroke 0 32 0.0 3 53 5.7 10 63 15.9 4 59 6.8 17 207 8.2 917 7.0 10,237 7.9 1100 Peripheral arterial disease 3 32 9.4 4 52 7.7 5 63 7.9 5 58 8.6 17 205 8.3 1,022 7.8 12,428 9.6 1101 Home medications 1102 Aspirin 4,196 41.4 45,298 43.3 1103 Clopidogrel 1,043 10.3 14,867 14.2 1104 Ticlopidine 2 0.0 101 0.1 1105 Prasugrel 81 0.8 1,193 1.1 1106 Warfarin 478 4.7 5,182 5.0 1107 Beta blocker 3,443 33.9 40,177 38.4 1108 ACE inhibitor 2,623 25.9 30,129 28.8 1109 Angiotensin receptor blocker 1,058 10.4 11,065 10.6 1110 Aldosterone blocking agent 209 2.1 2,333 2.2 1111 Statin 3,956 39.0 42,109 40.2 1112 Non-statin lipid-lowering agent 719 7.1 9,352 8.9
All Patients Hospital Presentation My Hospital Registry Pts 1113 Hospital presentation 1114 Means of transport (first facility) 1115 Self/family 18 32 56.3 28 53 52.8 21 63 33.3 22 59 37.3 89 207 43.0 6,825 52.4 71,268 54.8 1116 Ambulance 14 32 43.8 25 53 47.2 42 63 66.7 37 59 62.7 118 207 57.0 6,078 46.6 57,173 44.0 1117 Mobile ICU 0 32 0.0 0 53 0.0 0 63 0.0 0 59 0.0 0 207 0.0 12 0.1 699 0.5 1118 Air 0 32 0.0 0 53 0.0 0 63 0.0 0 59 0.0 0 207 0.0 122 0.9 868 0.7 1119 Means of transfer (outside facility) 1120 Ambulance 5 5 100.0 6 6 100.0 11 11 100.0 2,207 63.7 27,634 73.6 1121 Mobile ICU 0 5 0.0 0 6 0.0 0 11 0.0 127 3.7 2,066 5.5 1122 Air 0 5 0.0 0 6 0.0 0 11 0.0 1,133 32.7 7,831 20.9 1123 Location of first evaluation 1124 ED 7,571 74.6 75,706 72.3 1125 Median hours from arrival to transfer out from ED 2.3 2.7 1126 Cath lab 941 9.3 12,660 12.1 1127 Other 1,631 16.1 16,332 15.6 1128 First ECG obtained 1129 Pre hospital (3) 7 32 21.9 16 53 30.2 30 58 51.7 26 53 49.1 79 196 40.3 3,187 33.4 26,534 28.7 1130 After 1st hospital arrival 25 32 78.1 37 53 69.8 28 58 48.3 27 53 50.9 117 196 59.7 6,366 66.6 65,856 71.3 1131 Median time to 1st ECG (in min) 1132 ECG <= 10 min of presentation 1133 STEMI ECG findings 7.0 10.0 7.5 7.0 8.0 7.0 7.0 18 25 72.0 20 37 54.1 17 28 60.7 20 27 74.1 75 117 64.1 4,101 64.8 41,719 63.4 1134 ST elevation 9 9 100.0 11 11 100.0 26 26 100.0 30 30 100.0 76 76 100.0 5,079 97.0 49,014 96.9 1135 LBBB 0 9 0.0 0 11 0.0 0 26 0.0 0 30 0.0 0 76 0.0 132 2.5 1,118 2.2 1136 Isolated posterior MI 0 9 0.0 0 11 0.0 0 26 0.0 0 30 0.0 0 76 0.0 27 0.5 430 0.9 1137 STEMI first noted 1138 First ECG 6 9 66.7 8 11 72.7 25 26 96.2 26 30 86.7 65 76 85.5 4,607 88.0 43,914 86.9 1139 Subsequent ECG 3 9 33.3 3 11 27.3 1 26 3.9 4 30 13.3 11 76 14.5 626 12.0 6,624 13.1 1140 Other ECG findings 1141 New or presumed new ST depression 1142 New or presumed new T-wave inversion 1143 Transient ST elevation lasting <20 min 4 23 17.4 7 42 16.7 5 35 14.3 5 29 17.2 21 129 16.3 1,879 24.2 15,701 19.8 3 23 13.0 5 42 11.9 5 35 14.3 5 29 17.2 18 129 14.0 1,212 15.6 10,324 13.0 1 23 4.4 5 42 11.9 0 35 0.0 0 29 0.0 6 129 4.7 217 2.8 1,612 2.0
All Patients Hospital Presentation My Hospital Registry Pts 1144 None 15 23 65.2 25 42 59.5 25 35 71.4 19 29 65.5 84 129 65.1 4,444 57.3 51,559 65.1 1145 Median time from symptom onset to presentation (hours) (2) 2.0 3.8 1.8 2.1 2.0 2.0 2.0 1146 >= 6 hours 8 32 25.0 19 53 35.9 17 58 29.3 14 53 26.4 58 196 29.6 1,649 19.1 14,770 18.6 1147 < 6 hours 24 32 75.0 34 53 64.2 41 58 70.7 39 53 73.6 138 196 70.4 6,645 76.9 60,057 75.5 1148 Cardiac status on first medical contact 1149 Heart failure 7 32 21.9 17 53 32.1 22 63 34.9 13 59 22.0 59 207 28.5 1,709 13.1 18,047 13.9 1150 Cardiogenic shock 1 32 3.1 2 52 3.9 5 63 7.9 0 59 0.0 8 206 3.9 660 5.1 5,468 4.2 1151 Hypotension 3 32 9.4 1 53 1.9 2 63 3.2 1 59 1.7 7 207 3.4 690 5.3 6,096 4.7 1152 Tachycardia 7 32 21.9 13 53 24.5 21 63 33.3 10 59 17.0 51 207 24.6 2,552 19.6 26,581 20.5 1153 Cocaine use 68 0.7 1,100 1.1 1154 Cardiac arrest 1 31 3.2 0 53 0.0 3 63 4.8 0 59 0.0 4 206 1.9 613 4.7 5,325 4.1 1155 Pre-hospital 1 1 100.0 3 3 100.0 4 4 100.0 463 75.5 3,750 70.4 1156 Outside facility 0 1 0.0 0 3 0.0 0 4 0.0 106 17.3 1,160 21.8
All Patients Acute and In-Hospital Medications and Dosing Errors My Hospital Registry Pts 1157 Acute and in-hospital medications and dosing errors 1158 Any acute oral antiplatelet 28 30 93.3 51 52 98.1 59 60 98.3 56 57 98.3 194 199 97.5 11,883 98.3 118,736 98.4 1159 Aspirin 27 30 90.0 52 53 98.1 60 62 96.8 58 59 98.3 197 204 96.6 12,405 97.7 123,935 97.7 1160 Clopidogrel 21 32 65.6 30 52 57.7 28 61 45.9 32 58 55.2 111 203 54.7 6,652 53.6 67,297 54.2 1161 Ticlopidine 0 32 0.0 0 53 0.0 0 63 0.0 0 59 0.0 0 207 0.0 5 0.0 77 0.1 1162 Prasugrel 3 32 9.4 6 53 11.3 11 63 17.5 11 58 19.0 31 206 15.1 2,012 15.9 19,776 15.8 1163 Beta blocker 21 26 80.8 35 44 79.6 48 57 84.2 54 55 98.2 158 182 86.8 9,533 85.1 98,930 85.7 1164 ACE inhibitor 3,952 44.6 40,109 43.2 1165 Angiotensin receptor blocker 691 7.5 7,000 7.2 1166 Aldosterone blocking agent 209 2.1 2,092 2.0 1167 Statin 6,712 69.0 67,261 66.6 1168 Non-statin lipid-lowering agent 354 3.5 5,925 5.7 1169 GP IIb/IIIa inhibitor 3 32 9.4 6 52 11.5 7 63 11.1 4 59 6.8 20 206 9.7 3,717 29.0 43,532 34.2 1170 Eptifibatide 3 3 100.0 6 6 100.0 7 7 100.0 3 4 75.0 19 20 95.0 2,661 71.6 36,082 82.9 1171 Full dose 1,674 81.9 24,735 84.3 1172 Reduced dose 248 12.1 2,793 9.5 1173 Other 121 5.9 1,705 5.8 1174 Tirofiban 0 3 0.0 0 6 0.0 0 7 0.0 0 4 0.0 0 20 0.0 333 9.0 850 2.0 1175 Full dose 191 57.4 589 75.1 1176 Reduced dose 21 6.3 47 6.0 1177 Other 117 35.1 142 18.1 1178 Abciximab 0 3 0.0 0 6 0.0 0 7 0.0 1 4 25.0 1 20 5.0 715 19.2 6,532 15.0 1179 Any GP IIb-IIIa inhibitor among PCI patients 3 18 16.7 5 35 14.3 7 35 20.0 4 39 10.3 19 127 15.0 3,397 41.3 38,297 48.3 1180 Started infusion pre-pci (4) 0 3 0.0 0 5 0.0 1 7 14.3 0 4 0.0 1 19 5.3 335 9.9 5,750 15.0 1181 Started infusion peri-pci (5) 3 3 100.0 5 5 100.0 6 7 85.7 4 4 100.0 18 19 94.7 3,049 89.8 32,394 84.6 1182 Anticoagulant 29 32 90.6 49 52 94.2 55 62 88.7 57 58 98.3 190 204 93.1 11,860 92.2 119,823 93.4 1183 IV unfractionated heparin 17 29 58.6 12 49 24.5 23 55 41.8 23 57 40.4 75 190 39.5 8,201 69.2 84,309 70.4 1184 LMWH 13 29 44.8 30 49 61.2 25 55 45.5 29 57 50.9 97 190 51.1 3,513 29.6 37,852 31.6 1185 Enoxaparin 13 29 44.8 30 49 61.2 25 55 45.5 29 57 50.9 97 190 51.1 3,156 26.6 36,538 30.5 1186 Initial IV bolus 220 9.3 2,570 8.7 1187 SubQ doses 1188 q 12 hours 909 38.2 11,949 40.1 1189 q 24 hours 585 24.6 8,333 28.0
All Patients Acute and In-Hospital Medications and Dosing Errors My Hospital Registry Pts 1190 Dalteparin 0 29 0.0 0 49 0.0 0 55 0.0 0 57 0.0 0 190 0.0 401 3.4 1,454 1.2 1191 Fondaparinux 0 29 0.0 0 49 0.0 0 55 0.0 0 57 0.0 0 190 0.0 34 0.3 509 0.4 1192 Direct thrombin inhibitors 15 29 51.7 31 49 63.3 33 55 60.0 37 57 64.9 116 190 61.1 4,311 36.4 39,357 32.9 1193 Bivalirudin 15 29 51.7 31 49 63.3 33 55 60.0 37 57 64.9 116 190 61.1 4,307 36.3 39,251 32.8 1194 Argatroban 0 29 0.0 0 49 0.0 0 55 0.0 0 57 0.0 0 190 0.0 7 0.1 119 0.1 1195 Lepirudin 0 29 0.0 0 49 0.0 0 55 0.0 0 57 0.0 0 190 0.0 2 0.0 25 0.0 1196 Dosing errors for anticoagulants and GP IIb- IIIa inhibitors 1197 Heparin, IV UFH-overall (all AMI) 1,000 49.9 11,373 48.1 1198 Bolus 853 85.3 8,893 78.2 1199 Infusion 448 44.8 5,838 51.3 1200 Enoxaparin-overall 1201 Initial Dose > 1.05 mg/kg 192 14.7 1,901 11.5 1202 GP IIb-IIIa Inhibitor (All AMI) 123 5.5 2,024 7.1
All Patients In-Hospital Procedures My Hospital Registry Pts 1203 In-hospital procedures 1204 Non-invasive stress test 476 4.7 4,997 4.8 1205 Diagnostic coronary angiography 1206 Cath without prior noninvasive stress testing 1207 Diagnostic cath results 1208 Non-obstructive CAD - all vessels <50% 1209 Pt with no CAD (all native vessels <=10% stenosis) (w/o CABG) 1210 Diseased vessels (including LM disease) 24 32 75.0 44 53 83.0 49 63 77.8 52 59 88.1 169 207 81.6 11,202 86.0 111,393 85.7 8,510 97.0 86,724 96.3 438 5.6 5,233 6.6 259 3.3 2,891 3.7 1211 LM disease (>=50%) 769 8.8 7,849 8.7 1212 LM and RCA disease (triple vessel) 1213 LM w/out RCA disease (double vessel) 1214 Diseased vessel w/or w/o LM 549 6.3 5,550 6.2 220 2.5 2,299 2.6 1215 Single vessel disease 3,726 42.4 37,490 41.5 1216 Double vessel disease 2,439 27.8 25,478 28.2 1217 Triple vessel disease 1,980 22.5 19,626 21.7 1218 LV function 1219 Normal (EF >=50%) 15 32 46.9 27 53 50.9 29 63 46.0 34 59 57.6 105 207 50.7 7,430 57.0 68,510 52.7 1220 Mildly reduced (EF 40-49%) 10 32 31.3 13 53 24.5 15 63 23.8 19 59 32.2 57 207 27.5 2,408 18.5 25,320 19.5 1221 Moderately reduced (EF 25-39%) 5 32 15.6 7 53 13.2 10 63 15.9 4 59 6.8 26 207 12.6 1,753 13.4 20,200 15.5 1222 Severely reduced (EF <25%) 1 32 3.1 2 53 3.8 6 63 9.5 1 59 1.7 10 207 4.8 450 3.5 6,237 4.8 1223 Not Assessed 1 32 3.1 4 53 7.6 3 63 4.8 1 59 1.7 9 207 4.4 967 7.4 9,434 7.3 1224 Revascularization status (6) 1225 PCI 18 30 60.0 32 45 71.1 30 52 57.7 33 47 70.2 113 174 64.9 7,804 64.9 76,585 64.5 1226 Stent type 1227 Bare metal stent 5 15 33.3 4 30 13.3 11 29 37.9 11 33 33.3 31 107 29.0 2,086 28.9 22,362 31.5 1228 Drug eluting stent 10 15 66.7 26 30 86.7 18 29 62.1 22 33 66.7 76 107 71.0 5,171 71.7 48,809 68.8 1229 Other 0 15 0.0 0 30 0.0 0 29 0.0 0 33 0.0 0 107 0.0 10 0.1 313 0.4 1230 CABG 0 30 0.0 2 45 4.4 4 52 7.7 5 47 10.6 11 174 6.3 1,176 9.8 10,252 8.6 1231 No revascularization 12 30 40.0 12 45 26.7 18 52 34.6 10 47 21.3 52 174 29.9 3,217 26.8 33,412 28.1
All Patients Reperfusion Use My Hospital Registry Pts 1232 Reperfusion use 1233 Reperfusion candidates 9 9 100.0 11 11 100.0 24 26 92.3 30 30 100.0 74 76 97.4 4,491 85.8 42,483 84.1 1234 Transfers 3 3 100.0 5 5 100.0 8 8 100.0 1,188 87.0 13,116 84.6 1235 Non-transfers 9 9 100.0 11 11 100.0 21 23 91.3 25 25 100.0 66 68 97.1 3,303 85.4 29,367 83.9 1236 Reason contraindication to reperfusion 1237 Primary reason for no reperfusion 1238 Reason primary PCI not performed 1239 Reason thrombolytics not administered 1240 Reperfusion candidate, but no PCI or thrombolytics 295 99.7 2,992 99.0 553 14.7 4,637 12.4 3,185 84.5 31,060 83.1 6 0.2 41 0.1 1241 Any thrombolytics 0 9 0.0 0 11 0.0 0 24 0.0 1 30 3.3 1 74 1.4 546 11.4 3,048 6.6 1242 D2B for non transfers < =90 mins 5 7 71.4 10 11 90.9 20 20 100.0 24 25 96.0 59 63 93.7 2,798 94.5 25,075 94.6 1243 Median time (minutes) 83.0 65.0 61.5 51.0 61.0 59.0 58.0 1244 D2B for Transfers < = 90 mins 1 2 50.0 3 4 75.0 4 6 66.7 189 36.9 2,554 32.3 1245 Median time (minutes) 102.5 76.0 76.5 101.0 105.0 1246 <= 120 minutes 1 2 50.0 4 4 100.0 5 6 83.3 342 66.8 5,174 65.5 1247 Excluded from D2B non transfer and D2B transfers 1248 Door to needle (thrombolytics) <= 30 min 0 3 0.0 0 5 0.0 0 8 0.0 30 2.2 394 2.5 4 50.0 79 52.7 1249 Median (minutes) 31.0 29.5 1250 Non-system reason for delay 0 1 0.0 0 1 0.0 37 6.8 224 7.4 1251 Door in door out transfer in patients 3 3 100.0 4 5 80.0 7 8 87.5 622 45.5 9,534 61.5 1252 Median (minutes) 60.0 33.5 35.0 43.0 45.0 1253 PCI Indications 1254 PCI for STEMI 9 18 50.0 11 35 31.4 23 35 65.7 30 39 76.9 73 127 57.5 4,592 55.6 43,781 54.6 1255 Immediate, primary PCI for STEMI 9 9 100.0 11 11 100.0 23 23 100.0 30 30 100.0 73 73 100.0 3,975 86.6 39,967 91.3 1256 Rescue PCI 0 9 0.0 0 11 0.0 0 23 0.0 0 30 0.0 0 73 0.0 234 5.1 1,347 3.1 1257 Median time (minutes) 226.0 189.0 1258 Stable, successful reperfusion for STEMI or completed infarction post STEMI 0 9 0.0 0 11 0.0 0 23 0.0 0 30 0.0 0 73 0.0 282 6.1 1,567 3.6