Ischemic Heart Disease Interventional Treatment

Transcription

1 Ischemic Heart Disease Interventional Treatment Cardiac Catheterization Laboratory Procedures (N = 1,871) is a regional and national referral center for percutaneous coronary intervention (PCI). A total of 1,871 cardiac catheterization procedures were done in to treat patients with simple and complex ischemic heart disease. The data comparisons below demonstrate outcomes at compared with those at hospitals included in the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) CathPCI Registry that perform more than PCIs per year. Data are based on a 1-year rolling average; therefore, totals reported here may differ from those reported elsewhere in this book. Risk Factors Among Patients Undergoing PCI Procedures (N = 18) 6 3 Complex medical backgrounds can affect outcomes for patients who have PCI procedures. Patients who had PCI procedures at Cleveland Clinic in had more complex backgrounds in all categories, except advanced age, compared with comparable hospitals. 1 Age (> 7 years) Acute Care Transfer Prior MI Prior Heart Failure Diabetes Prior CABG Severe LV Dysfunction Multivessel Disease Abbreviations: CABG = coronary artery bypass grafting, LV = left ventricular, MI = myocardial infarction Use of Adjunctive Medications Before and After PCI Procedures (N = 18) One of the ACC-NCDR key performance measures is the use of appropriate adjunctive medications before and after PCI. Cleveland Clinic s administration rates exceed those of comparable hospitals. 8 Aspirin on Admission Before Procedure Aspirin Statins At Discharge Thienopyridines 13

2 Ischemic Heart Disease Interventional Treatment (continued) PCI Procedure Complications (N = 18) 8 6 In, the rates of major vascular complications and stroke associated with PCI procedures at Cleveland Clinic were better than the rates at comparable hospitals. The rate of risk-adjusted bleeding events was slightly higher. Patients at Cleveland Clinic had greater risk factors than patients at similar hospitals. is continuously striving to achieve the best possible outcomes for patients. Composite: Death, Emergency CABG, Stroke, or Repeat Target Vessel Revascularization Stroke Risk-Adjusted Bleeding Event Abbreviation: CABG = coronary artery bypass grafting PCI Procedure, In-Hospital Mortality (N = 18). 1. The rate of in-hospital mortality among patients who had PCI procedures at in was slightly lower compared with rates at comparable hospitals. 1.. Risk-Adjusted Mortality Door-to-Balloon Time (N = ) a Minutes Comparable ACC-NCDR hospitals ACC/AHA goal The American College of Cardiology/American Heart Association (ACC/AHA) guideline for PCI inflation for patients who come to the emergency department with ST-elevated myocardial infarction (STEMI) was recently changed from 9 to 6 minutes. continues to improve door-to-balloon time to reduce the risk of mortality and morbidity. In, the median time at was 6 minutes. a A total of patients treated for myocardial infarction at s emergency department met the ACC-NCDR reporting criteria for a primary diagnosis of STEMI. Among these patients, time to reperfusion was 6 minutes. 1 Outcomes

3 PCI Procedures Total Chronic Occlusion Technical Success With Hybrid Approach The risks and complexity of PCI procedures for patients with total chronic occlusion are greater than that of standard PCI. physicians are skilled in these procedures and had greater success rates than did physicians at comparable hospitals in Success Rate PCI Procedures Radial Access (N = 9) In, performed more PCI procedures using radial access than did other comparable hospitals. The use of radial access is associated with reductions in bleeding complications, readmission rates, infection, and recovery time compared with PCI procedures done using a femoral approach. 3 1 Radial Access 1

4 Outcomes Ischemic Heart Disease Surgical Treatment Surgical Treatment for Ischemic Heart Disease (N = 17) CABG Volume surgeons performed 17 coronary artery bypass graft (CABG) procedures in. A total of 6 were in combination with another procedure and 9 were isolated procedures, including reoperations. Procedure Volume Isolated 9 CABG + Other 6 CABG Volume, Primary and Reoperations 1% Reoperations (N = 18) The majority of CABG procedures at in were primary operations. A primary operation is the first time a patient has a particular procedure. Reoperations are repeat procedures and are considerably more complex. 1% 8% Primary operations (N = 16) CABG + Other, In-Hospital Mortality (N = 6) In-hospital mortality rates among patients who had CABG surgery plus another procedure at in (primary and reoperations) were lower than expected CABG + Other. Source: Data from the UHC Clinical Data Base/Resource Manager TM used by permission of UHC. All rights reserved. 16 Outcomes

5 Isolated CABG Procedures, In-Hospital Mortality (N = 9) surgeons performed 9 isolated CABG procedures in. The overall inpatient hospital mortality rate was 1.% (N = 7), which was lower than the expected rate of.%. Volume 6 3 STS CABG Quality Ratings Overall Source: Data from the UHC Clinical Data Base/Resource Manager TM used by permission of UHC. All rights reserved. Isolated CABG Procedures, In-Hospital Mortality Primary and Reoperation (N = 9) Many patients who have CABG reoperations at have very complex medical histories, which creates a higher risk of death. Despite these increased risks, the inpatient hospital mortality rates at were 3.% (N = ) for reoperations and.7% (N = ) for primary operations. Both rates were lower than expected Primary.9 3. Reoperation 3.8 Source: Data from the UHC Clinical Data Base/Resource Manager TM used by permission of UHC. All rights reserved. Approximately 1% - 1% of US hospitals received the STS 3 star rating for CABG surgery. This denotes the highest category of quality. In the current analysis of national data covering the period from July 1, 13, through June 3,, the CABG surgery performance at was found to lie in this highest quality tier, thereby earning the STS 3-star rating. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 17

6 Ischemic OutcomesHeart Disease Surgical Treatment (continued) CABG Procedures, Long-Term Follow-Up Diabetic Patients Survival (%) is committed to long-term follow-up, as it is essential to understanding the overall impact of medical and surgical procedures. Among data collected for patients who have CABG surgery, it is demonstrated that patients with diabetes tend to have lower rates of long-term survival compared with nondiabetic patients. Nondiabetic Diabetic Years Isolated CABG: Additional Outcomes Deep Sternal Wound Infection The rate of deep sternal wound infection after CABG surgery was lower than expected at in. The rate at was.% compared with the expected rate of.3%. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database Outcomes

7 Ventilator Time > Hours A total of 9.6% of patients who had isolated CABG surgery at in spent more than hours on a ventilator. This is lower than the expected rate of 1%. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database In-Hospital Reoperation The rate of in-hospital reoperation after isolated CABG surgery was lower than expected at in. 1 1 Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 3. Postoperative Stroke The expected rate of postoperative stroke after isolated CABG surgery was 1.% in. The rate was lower (.8%) at Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database

8 Outcomes Ischemic Heart Disease AMI Postoperative Renal Failure Postoperative renal failure occurred in.% of patients who had isolated CABG surgery at in. This was lower than the expected rate of 3.7% Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database. 3.7 Coppliance With Process Measures was 1% compliant in with all Society of Thoracic Surgeons process measures. The process measures include the use of a perioperative beta blocker; use of a beta blocker, statin, and aspirin at discharge; and use of an internal mammary artery during isolated CABG surgery. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database Q1 Q Q3 Q Outcomes

9 Acute Myocardial Infarction Acute Myocardial Infarction All-Cause 3-Day Mortality and All-Cause 3-Day Readmissions July 11 June 3 National rate a 1 1 Mortality Readmissions N a = 716 a Source: medicare.gov/hospitalcompare N = eligible discharges The Centers for Medicare & Medicaid Services (CMS) calculates AMI outcomes measures based on Medicare claims and enrollment information. The most recent risk-adjusted data available from CMS are shown. Although s AMI patient mortality rate is slightly lower than the US national rate, CMS ranks s performance as no different than the US national rate. s AMI readmissions rate is slightly higher than the US national rate and also ranked by CMS as no different than the US national rate. To further reduce avoidable readmissions, is focused on optimizing transitions from hospital to home or postacute facility. Specific initiatives have been implemented to ensure effective communication, education, and follow-up. 1