Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry®–Get With The Guidelines (GWTG)™ acute myocardial infarction mortality model and risk score

Chin, Chee Tang; Chen, Anita Y.; Wang, Tracy Y.; Alexander, Karen P.; Mathews, Robin; Rumsfeld, John S.; Cannon, Christopher P.; Fonarow, Gregg C.; Peterson, Eric D.; Roe, Matthew T.

doi:10.1016/j.ahj.2010.10.004

Cited by 150 publications

(126 citation statements)

References 19 publications

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“…We thereafter assessed discharge ticagrelor use stratified by predicted risk of in‐hospital bleeding and mortality (ACTION bleeding5and mortality6 scores, respectively). These scores were previously derived and validated using the ACTION Registry‐GWTG data.…”

Section: Methodsmentioning

confidence: 99%

Ticagrelor Use in Acute Myocardial Infarction: Insights From the National Cardiovascular Data Registry

Basra¹,

Wang

Simon

et al. 2018

JAHA

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BackgroundTicagrelor is a P2Y12 receptor inhibitor with superior clinical efficacy compared with clopidogrel. However, it is associated with reduced efficacy when combined with a high‐dose aspirin.Methods and ResultsPatients in the acute coronary treatment and intervention outcomes network (ACTION) Registry‐Get With The Guidelines (GWTG) with acute myocardial infarction from October 2013 through December 2014 were included in the study (167 455 patients; 622 sites). We evaluated temporal trends in the prescription of P2Y12 inhibitors, and identified factors associated with ticagrelor use at discharge. Among patients discharged on ticagrelor and aspirin (21 262 patients), we evaluated the temporal trends and independent factors associated with high‐dose aspirin prescription at discharge. Ticagrelor prescription at discharge increased significantly from 12% to 16.7% (P<0.0001). Decreases in prasugrel and clopidogrel use at discharge (15.7%–13.9% and 54.2%–51.1%, respectively, P<0.0001) were also observed. Independent factors associated with preferential ticagrelor prescription at discharge over clopidogrel included younger age, white race, home ticagrelor use, invasive management, and in‐hospital re‐infarction and stroke (P<0.0001 for all), whereas older age, female sex, prior stroke, home ticagrelor use, and in‐hospital stroke (P<0.0001 for all) were associated with preferential ticagrelor prescription at discharge over prasugrel. High‐dose aspirin was used in 3.1% of patients discharged on ticagrelor. Independent factors associated with high‐dose aspirin prescription at discharge included home aspirin use, diabetes mellitus, previous myocardial infarction, previous coronary artery bypass graft, ST‐segment–elevation myocardial infarction, cardiogenic shock, and geographic region (P=0.01).ConclusionsOur contemporary analysis shows a modest but significant increase in the use of ticagrelor and a high rate of adherence to the use of low‐dose aspirin at discharge.

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Section: Methodsmentioning

confidence: 99%

Ticagrelor Use in Acute Myocardial Infarction: Insights From the National Cardiovascular Data Registry

Basra¹,

Wang

Simon

et al. 2018

JAHA

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“…Linearity for C2D time with respect to log odds of in‐hospital mortality was checked. The model consisted of a list of patient covariates from the previously validated ACTION Registry–GWTG in‐hospital mortality (Data S1) 19. These included demographics, medical comorbidities, signs and symptoms at presentation, relevant laboratory results, home medications, insurance status, mode of transportation, use of prehospital ECG, and time from symptom onset to first medical contact.…”

Section: Methodsmentioning

confidence: 99%

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Roswell

Kunkes

Chen

et al. 2017

JAHA

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BackgroundEmergent myocardial reperfusion via primary percutaneous coronary intervention is optimal care for patients presenting with ST‐segment elevation myocardial infarction (STEMI). Delays in such interventions are associated with increases in mortality. With the shift in focus to contact‐to‐device (C2D) time as a new perfusion metric, this study was designed to examine how sex affects C2D time and mortality in STEMI patients.Methods and ResultsClinical data on male and female STEMI patients were extracted and analyzed from the National Cardiovascular Data Registry from July 1, 2008 to December 31, 2014. A total of 102 515 patients were included in the final analytic cohort. The median C2D time in female patients with STEMI was delayed when compared to male patients (80 [65–97] versus 75 [61–90] minutes; P<0.001). The unadjusted mortality was higher in female patients when compared to male patients with STEMI (4.1% versus 2.0%; P<0.001). For every 5‐minute increase in C2D time, the adjusted odds ratio for mortality was 1.04 (95% CI, 1.03–1.06) for female patients with STEMI and 1.07 (95% CI, 1.06–1.09) for male patients (P for sex by C2D interaction=0.003).ConclusionsTo date, this is the largest analysis of STEMI patients that measures the impact of the new recommended C2D reperfusion metric on in‐hospital mortality. Female STEMI patients have longer C2D times and increased mortality. The disparity can be improved and survival can increase in this high‐risk patient cohort by decreasing systems issues that cause increased reperfusion times in female STEMI patients.

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“…The ACTION Registry in‐hospital mortality prediction risk model was derived and validated in a population of patients with MI 14. Briefly, the model consists of the following variables: age, systolic blood pressure, heart rate at admission, presence of heart failure and/or shock on admission, ST‐segment changes, initial serum creatinine, initial troponin (ratio over institutional upper limit of normal), and the presence or absence of prior peripheral artery disease to estimate predicted in‐hospital mortality risk.…”

Section: Methodsmentioning

confidence: 99%

“…Briefly, the model consists of the following variables: age, systolic blood pressure, heart rate at admission, presence of heart failure and/or shock on admission, ST‐segment changes, initial serum creatinine, initial troponin (ratio over institutional upper limit of normal), and the presence or absence of prior peripheral artery disease to estimate predicted in‐hospital mortality risk. As a summary measure of patient risk factors, we calculated the ACTION in‐hospital mortality risk score (ACTION mortality risk score) for each patient, and patients were divided into low (<30), medium (30–40), and high risk (>40) categories 14. We used the thresholds defined in the initial derivation of the ACTION mortality risk score,14 which have been used in other analyses 15.…”

Section: Methodsmentioning

confidence: 99%

“…As a summary measure of patient risk factors, we calculated the ACTION in‐hospital mortality risk score (ACTION mortality risk score) for each patient, and patients were divided into low (<30), medium (30–40), and high risk (>40) categories 14. We used the thresholds defined in the initial derivation of the ACTION mortality risk score,14 which have been used in other analyses 15. As in prior studies,16 in‐hospital major bleeding was defined as a hemoglobin decrease of ≥4 g/dL, intracranial hemorrhage, documented or suspected retroperitoneal bleed, any red cell blood transfusion with baseline Hb ≥ 9 g/dL, or any red cell transfusion with Hb <9 g/dL and a suspected bleeding event.…”

Section: Methodsmentioning

confidence: 99%

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Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction

Rymer

Chen

Thomas

et al. 2018

JAHA

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BackgroundPhysician shortages and reimbursement changes have led to greater use of advanced practice providers (APPs). Prevalence of and outcomes associated with APP care following myocardial infarction are unknown.Methods and ResultsWe examined outpatient cardiology or primary care visits within 90 days post‐myocardial infarction among 29 477 Medicare‐insured patients aged ≥65 years from 364 hospitals in Acute Coronary Treatment Intervention Outcomes Network Registry. We compared medication adherence, all‐cause readmission risk, mortality, and major adverse cardiovascular events between patients seen by APPs versus physicians only. Overall, 11% of myocardial infarction patients were treated by an APP. Patients seen by APPs were more likely to have diabetes mellitus (37% versus 33%) and heart failure (20% versus 16%), be discharged to a nursing facility (21% versus 13%) and had more outpatient visits within 90 days post‐discharge (median 6 versus 5, P<0.01 for all) than those seen by physicians only. Adherence to evidence‐based medications (adjusted odds ratio, 0.98; 95% confidence interval, 0.89–1.08) and readmission risks (adjusted hazard ratio, 1.11; 95% confidence interval, 0.99–1.26) were similar between patients seen by APPs versus physicians only. Risks of 90‐day mortality (adjusted hazard ratio, 1.18; 95% confidence interval, 0.98–1.42) and major adverse cardiovascular events (adjusted hazard ratio, 1.06; 95% confidence interval, 0.90–1.23) were also similar between patients seen by APPs versus physicians only.Conclusions APPs were likely used to provide more frequent monitoring of high‐risk post‐MI patients. Medication adherence, readmission risk, mortality, and major adverse cardiovascular events did not differ substantially between patients seen by physician‐APP teams than those seen by physicians only.

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Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: The Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry®–Get With The Guidelines (GWTG)™ acute myocardial infarction mortality model and risk score

Cited by 150 publications

References 19 publications

Ticagrelor Use in Acute Myocardial Infarction: Insights From the National Cardiovascular Data Registry

Ticagrelor Use in Acute Myocardial Infarction: Insights From the National Cardiovascular Data Registry

Impact of Sex and Contact‐to‐Device Time on Clinical Outcomes in Acute ST‐Segment Elevation Myocardial Infarction—Findings From the National Cardiovascular Data Registry

Advanced Practice Provider Versus Physician‐Only Outpatient Follow‐Up After Acute Myocardial Infarction

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