ACTION Registry-GWTG New User Training Webinar February 7,2013

1. ACTION Registry-GWTG New User Training Webinar February 7,2013

2. Purpose of ACTION Registry-GWTG • National surveillance system for high-risk AMI patients admitted with STEMI/NSTEMI: • Assess characteristics, treatments, and outcomes of this patient population • Optimize outcomes and management of AMI patients through implementation of ACC/AHA evidence-based guideline recommendations in clinical practice • Facilitate efforts to improve quality and safety of ACS patient care; and investigate QI methods

3. The History: ACTION Registry-GWTG • ACTION Registry transitioned from CRUSADE and NRMI Registries • January 2007 ACTION was established • May 2008 ACTION merged with AHA GWTG CAD to become ACTION Registry-GWTG • Current membership of 800 Hospitals • 500,000 records submitted

4. Data Collection Options Web-Based Data Capture • Secure, password-protected data entry system • Free NCDR data collection tool • Interoperability from Cath/PCI Registry to ACTION • Vendor-Based Data Capture • Data submitted via encrypted, password-protected file • Interoperability between ACTION and Cath/PCI Registry

5. www.ncdr.com Participant Log In

6. The ACTION Registry-GWTG Webpage

11. Call the American Hospital Association 1-800-424-4301

14. The Dashboard

20. Technical Data Dictionary

21. Outcomes Report Companion Guide

22. Inclusion Population • Acute Myocardial Infarctions-STEMI & NSTEMI • Patient must present to 1st Facility with symptoms of ACS, within 24 hours of arrival • Patient must have positive ECG- ST elevation, new LBBB, or documented Posterior MI OR • Positive Biomarkers- Troponin or CK-MB within 24 hours of arrival • Transfer In patients- STEMI must arrive within 72 hours, NSTEMI within 24 hours • If presents with any other symptoms, or procedures, the patient is excluded

23. Choosing the Correct FormPremier Form or Limited Form Every Hospital Has The Option To Use Either Form

24. ACTION Registry-GWTG Premier Form • Complete quarterly Outcome Report for benchmarking • Report on 17 Core Performance Measures • Report on 12 Quality Metrics • Sites are Eligible for Higher Level of Recognition Program

25. ACTION Registry-GWTG Limited Form • 50% of full ACTION data set • Limited quarterly Outcome Report for benchmarking • Report on 17 Core Performance Measures • Report on 7 Quality Metrics • Lower level of Recognition

26. Limited Form: Pros and Cons Pros Fewer Data Elements Less time required for data abstraction and entry Accommodating for Non PCI Centers Great form for new sites to start Cons No Excessive dosing Reports for Anticoagulants Lower Level of Recognition Limited Quarterly Outcomes Report Not all the metrics are included

27. Premier Form: Pros and Cons Pros Detailed Quarterly Excessive Dosing Reports for Anticoagulants Higher level of Recognition Robust Data Set Full Quarterly Outcomes Report Cons More time required for data abstraction and entry Answering fields that are less likely to pertain to Non-PCI Centers

28. Demographics

29. Cardiac Status & History

30. Medications

31. Anticoagulants

32. Procedures

33. Reperfusion Strategy

34. Clinical Events & Biomarkers

35. Labs

36. Discharge

37. Section K- Optional Elements

38. Data Quality Reports(DQR)

40. Data Assessment Results

41. Failed Completeness Assessment

42. ACTION Registry-GWTG National Data Slide Sets Produced every 6 months

43. Use of Reperfusion Therapy for STEMI STEMI N = 21,978 Reperfusion N = 17,711 (81%) Not Eligible for Reperfusion Therapy Contraindication Listed N= 2,866 (13%) No Reperfusion – No Contraindication Listed N = 1272 (6%) Primary PCI – 86%* Fibrinolytics – 13%* Both PCI + Lytics – 1%* 93% of eligible patients reperfused ACTION Registry-GWTG DATA: July 1, 2008 – June 30, 2009 * Among patients receiving reperfusion

44. ACTION Door-to-Balloon Times –Median Times for Transfer In and Non-Transfer In Patients 250 240 236 230 223 220 215 212 210 200 190 180 170 169 160 158 151 156 150 Time (min) 140 123 130 120 120 116 113 103 110 102 100 96 95 90 79 78 80 75 74 70 62 60 60 57 57 50 40 30 20 10 0 Q1 07 Q2 07 Q3 07 Q4 07 Transfer in DTB Times Non-Transfer in DTB Times

45. STEMI Door-to-Balloon Times –Median Times for Transfer In and Non-Transfer In Patients 250 240 230 220 210 200 190 182 180 165 170 160 157 150 150 Time (min) 140 130 130 123 120 117 120 110 100 102 88 96 94 97 84 82 90 79 80 70 70 67 66 64 60 50 53 52 51 50 40 30 20 10 0 Q1 08 Q2 08 Q3 08 Q4 08 Transfer in DTB Times Non-Transfer in DTB Times

46. STEMI – Door to Balloon and Door to Needle Times:Cumulative 12 Month Data ACTION Registry-GWTG DATA: July 1,2008 – June 30, 2009 DTB = 1st Door to Balloon for Primary PCI DTN = Door to Needle for Lytics

47. NSTEMI Acute Medication Overdosing Trends * Infusion (> 15 units/kg/hr) or bolus (> 70 units/kg) # Initial dose (> 1.05 mg/kg) or total 24 hr dose (> 10 mg over recommended) ACTION Registry-GWTG DATA: July 1, 2008 – June 30, 2009

48. Quarterly Outcomes Reports

49. Composite Measure

50. Composite Measure Overall AMI Performance Graph