CLINICAL
NEWS NCDR UPDATE
However, significant
regional and
hospital variability
exists representing
opportunity for further
improvement.
In Case You Missed It:
NCDR at ACC.16
News and data from studies drawing from the
National Cardiovascular Data Registry (NCDR)
abounded in Chicago this past April at ACC.16.
Here are some of the interesting NCDR-related
findings you may have missed at the meeting.
How Does TAVR Impact Readmissions?
And Who’s Better at Referral?
Sreekanth Vemulapalli, MD, and colleagues
from the Duke Clinical Research Institute (DCRI)
used data from The Society of Thoracic Surgeons/
ACC TVT Registry to analyze pre- and posttranscatheter aortic valve replacement (TAVR)
hospitalizations in nearly 24,000 patients. In the
year after TAVR, patients had fewer heart failure
(HF) admissions (20.4% vs. 11.4%, respectively;
p <0.001) and fewer any cause hospital admissions (61.7% vs. 51.7%, respectively; p <0.001).
This translated to decreased Medicare costs for
28 CardioSource WorldNews
patients who remained alive 1-year post-TAVR.
The value of TAVR has been clearly established
and is showing benefits in even moderate-risk
patients with aortic stenosis (AS). Timeliness of
referral for these patients is important, but until
now there has been little information regarding
referral patterns.
Cassandra Ramm, MSN, AGNP-C, of the
University of North Carolina, was first-author
of a poster evaluating nine large valve treatment
centers participating in the ACC’s Championing
Care for the Patient with Aortic Stenosis initiative.
Among 454 patients referred for AS management, non-cardiologists did a better job, referring
patients earlier in the disease course than cardiologists.
According to the valve center physicians, patients referred by cardiologists were more likely to
have been referred “late” or “too late” (14% vs. 7%,
p = 0.004), whereas non-cardiologists were more
likely to refer “too early” (12% vs. 3%; p = 0.04).
Also, patients referred by cardiologists were
more likely to have advanced heart failure (New
York Heart Association functional class IV: 31%
vs. 7%; p < 0.0001) and trended towards higher
STS risk scores (p = 0.06) than those referred by
non-cardiologists.
Cardiologists appeared to be good at explaining TAVR to their patients, because individuals
they referred to the valve center were more likely
to strongly prefer TAVR at the time of the initial
consult than patients referred by non-cardiologists
(47% vs. 31%; p = 0.003).
Aspirin Dosing After ACS
Practice guidelines in the U.S. and Europe currently recommend treatment with a P2Y12 receptor antagonist for up to 1 year after myocardial
infarction (MI). Just before the Chicago meeting,
the ACC and AHA released a focused update on
duration of dual antiplatelet therapy (DAPT) in
patients with coronary artery disease (CAD).1
The new document notes that aspirin therapy
should almost always be continued indefinitely in
patients with CAD.
The focused update to several guidelines (percutaneous coronary intervention [PCI], coronary
artery bypass graft surgery, stable ischemic heart
June 2016