Cost Modifications during the Early Years of the Use of the National Cardiovascular Data Registry for Quality Improvement

Abstract

OBJECTIVES: Quality improvement (QI) initiatives based on data from international registries have been reported previously; however, there is a lack of information on the impact on the costs of medical care associated with the use of these tools. METHODS: Patients admitted due to myocardial infarction (MI), included in the ACTION Registry® and CathPCI Registry®, in a private Brazilian hospital (i.e., the reference hospital) were analyzed. The costs of care of these patients were compared to the costs of MI admissions in nine similar hospitals not included in the same QI program. Regression models were used to analyze the cost change over time between the two groups of hospitals. Readmission rates were compared using logistic regression, adjusting for the same variables as in the cost model. RESULTS: Overall, the annual medical cost inflation in Brazil was higher than the annual cost trend in the reference hospital during the period of analysis. Moreover, the annual in-hospital costs indicate that the reference hospital has a statistically significant 6% lower cost trend for patients with acute MI, compared to patients with the same diagnostic code in the comparison hospitals group, in an adjusted analysis ( p -value=0.041). Using multivariable analysis, the readmission rates were also found to be significantly lower in the reference hospital than in the comparison hospitals, with an odds ratio of 0.68 ( p -value=0.042). CONCLUSION: The use of the NCDR® as a benchmark to guide QI programs outside the United States was associated with the positive impact of bending the cost curve to below that of national medical inflation and the comparison hospitals’ costs, with a lower incidence of hospital readmission.

Intestinal Flora Metabolite Trimethylamine Oxide Is Inextricably Linked to Coronary Heart Disease

“… 59 One study on TMAO and vascular calcification in 179 patients with STEMI evaluated plasma TMAO levels using stable isotope dilution liquid chromatography–tandem mass spectrometry and the extent of vascular calcification through optical coherence tomography (OCT), finding a significant correlation between TMAO levels and the incidence of intimal calcification. 60 Because available investigations have only demonstrated a correlation between TMAO levels and endovascular calcification, the exact mechanism remains to be fully elucidated.…”

Gut Metabolite Trimethylamine-N-Oxide in Atherosclerosis: From Mechanism to Therapy

“…More than half of cardiovascular deaths are caused by ACS, and the main cardiovascular disorder causing these acute cardiovascular events is the development of atherosclerosis ( 24 ). TMAO is reported to be involved in vascular calcification and plaque instability, which are the key risk factors for malignant cardiovascular events ( 25 ).…”