The NCDR ACTION Registry–GWTG: transforming contemporary acute myocardial infarction clinical care
- Eric D Peterson1,
- Matthew T Roe1,
- Anita Y Chen1,
- Gregg C Fonarow2,
- Barbara L Lytle1,
- Christopher P Cannon3,
- John S Rumsfeld4
- 1Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
- 2University of California at Los Angeles Medical Center, Los Angeles, California, USA
- 3Brigham and Women's Hospital, Boston, Massachusetts, USA
- 4Denver VA Medical Center, Denver, Colorado, USA
- Correspondence to Dr Eric D Peterson, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA;
- Accepted 25 May 2010
- Published Online First 23 August 2010
Aims The NCDR ACTION Registry-GWTG collects detailed in-hospital clinical, process-of-care and outcomes data for patients admitted with acute myocardial infarction (AMI) in the USA. The registry is a national AMI surveillance system that contributes to the scientific enquiry process of AMI care through the facilitation of local and national quality improvement efforts.
Interventions No treatments are mandated, participating centres receive routine quality-of-care and outcomes performance feedback reports and access to quality of care tools, such as dosing algorithms and standing orders.
Population AMI patients are retrospectively identified. No informed consent is required, as data are anonymised. From January 2007 to date, 147 165 records have been submitted from 383 participating US hospitals. Patients with a primary diagnosis of ST-segment elevation myocardial infarction or non-ST-segment elevation myocardial infarction are eligible for enrolment in the registry. These patients must have ischemic symptoms and electrocardiogram changes, and/or positive cardiac markers within 24 hours of initial presentation.
Baseline data Approximately 350 fields encompassing patient demographics, medical history and risk factors, hospital presentation, initial cardiac status, medications and associated doses, reperfusion strategy, procedures, laboratory values, and outcomes. Data are manually entered by study personnel; there are non-financial incentives at the hospital level. Completeness within the registry is noteworthy with most fields at less than 5% missing.
Endpoints Main outcome measures include American College of Cardiology/American Heart Association myocardial infarction performance indicators, as well as in-hospital patient outcomes. Data are available for research by application to: http://www.ncdr.com.
Funding The ACTION Registry-GWTG is an initiative of the American College of Cardiology Foundation and the American Heart Association, with partnering support from the Society of Chest Pain Centers, the Society of Hospital Medicine and the American College of Emergency Physicians. The registry is sponsored by the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership and Schering-Plough Corporation. This project was supported by grant number U18HS016964 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the AHRQ. The funding source had no role in the design or implementation of the study, or in the decision to seek publication.
Conflicts of interest EDP: Research grants from Bristol-Myers Squibb, Eli Lilly and Otho McNeil Pharmaceuticals; MTR: Consultant to Bristol-Myers Squibb, Schering-Plough Corporation and Sanofi Pharmaceutical Partnership; AYC: None; GCF: Research grants from NIH; Honararium from GlaxoSmithKline, Medtronic, Sanofi-Aventis, Bristol Myers Squibb, Merck-Schering Plough, Pfizer, Novartis (all significant); Consultant to Novartis and Medtronic (significant), Pfizer, Sanofi-Aventis, Merck-Schering Plough (modest); BLL: None; CPC: Research grants from Accumetrics, AstraZeneca, Bristol-Myers Squibb/Sanofi Partnership, GlaxoSmithKline, Merck, Merck/Schering Plough Partnership (all significant); Clinical advisor to Automedics Medical Systems (equity modest); JSR: Chief Science Officer, NCDR; Scientific Advisory Board, United Healthcare.
Provenance and peer review Commissioned; externally peer reviewed.