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Global REACH Registry: Study Design

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Global REACH Registry: Study Design

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  1. Regional and Practice Variation in Adherence to Guideline Recommendations for Secondary and Primary Prevention Among Outpatients with Atherothrombosis or Risk Factors in the US: A Report From the REACH RegistryAmit Kumar, Gregg C. Fonarow, Kim A. Eagle, Alan T. Hirsch, Robert M. Califf, Mark J. Alberts, William E. Boden, P. Gabriel Steg, Mingyuan Shao, Deepak L. Bhatt, Christopher P. Cannon, on behalf of the REACH Registry Investigators

  2. Global REACH Registry: Study Design

  3. Global REACH Registry Objectives Primary Objective: To explore the impact of both classic and new risk factors on the prevalence of cardiovascular (CV) ischemic events among patients with, or at high risk for, atherothrombotic disease, on an international basis Additional Aims: Assess use of risk management strategies and 1-, 2-, 3- and 4-year outcomes in a broad outpatient population encompassing various geographic regions and physician specialties 1. Ohman EM et al, on behalf of the REACH Registry Investigators. Am Heart J 2006;151(4):786.e1-10.

  4. Global REACH Registry Inclusion Criteria • Male aged 65 yearsor female aged 70 years • Current smoking>15 cigarettes/day • Type 1 or 2diabetes • Hypercholesterolemia • Diabetic nephropathy • Hypertension • ABI <0.9 in eitherleg at rest • Asymptomatic carotidstenosis 70% • Presence of at leastone carotid plaque • Documented cerebrovascular diseaseIschemic stroke or TIA • (CVD) • Documentedcoronary diseaseAngina, MI, angioplasty/stent/bypass • (CAD) • Documented historicalor current intermittentclaudication associatedwith ABI <0.9 • (PAD) Must include: Signed written informed consent Patients aged ≥45 years At least of four criteria At least atherothrombotic risk factors 1 3 ABI, ankle-brachial index; MI, myocardial infarction; TIA, transient ischemic attack. 1. Ohman EM et al, on behalf of the REACH Registry Investigators. Am Heart J 2006;151(4):786.e1-10.

  5. Global REACH Registry Exclusion Criteria • Anticipated difficulty in patient returning for follow-up visit • Patient is currently hospitalized • Patient is currently participating in a clinical trial 1. Bhatt DL et al, on behalf of the REACH Registry Investigators. JAMA 2006;295(2):180-189.

  6. Global REACH Registry Timeline *Timelines are for worldwide participation; local timelines will be shorter

  7. Global Physician Selection • Participating physicians • Pre-defined at start of Registry • Based on local practice population • General practitioners, specialists • Mainly office-based, some hospital representation • Representative of: • Local environment • Country geography How were they selected? What is their profile? 1. Ohman EM et al, on behalf of the REACH Registry Investigators. Am Heart J 2006;151(4):786.e1-10.

  8. Main Specialty Breakdown of US Practitioner Involvement (n=1,599) GP or Internist 3.5% 86.8% 9.7% Cardiologist Endocrinologist, Neurologist, Vascular Surgeon, Angiologist, Other • Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):91-97.

  9. Global Patient Selection: Patients Fitting Inclusion Criteria • Patients • Recruitment at each site • Maximum 20 per site • Within overall Registry timelines • Patient inclusion criteria • Documented atherothrombotic disease, or with ≥3 atherothrombotic risk factors • Real-life setting How were they selected? What is their profile? 1. Ohman EM et al, on behalf of the REACH Registry Investigators. Am Heart J 2006;151(4):786.e1-10.

  10. REACH Registry:Adherence to Primary and Secondary Prevention Guidelines in the US

  11. Background and Objectives • Proven risk-reducing therapies for patients with or at risk for atherothrombotic events include antihypertensive, antiplatelet, antidiabetic, and lipid-lowering agents • Hospital-based studies have shown that better adherence to guideline-recommended risk-reducing therapies improves clinical outcomes • This analysis of the US cohort of the REACH Registry was undertaken to analyze the use of risk-reducing therapies for both primary and secondary atherothrombosis prevention, stratified by US Census Region and physician specialty • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  12. Patient Characteristics at Baseline – Stratified by US Census Region • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  13. US Patient Characteristics at Baseline – Stratified by Physician Specialty • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  14. Use of Risk-Reducing Medications at Baseline in US Patients – Total Population • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  15. Antidiabetes Medication Use at Baseline Among US Patients with Diabetes or Elevated Glucose – Stratified by Physician Specialty • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  16. Antihypertensive Medication Use at Baseline Among US Patients with Diagnosed Hypertension or Elevated BP at Enrollment – Stratified by Physician Specialty • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  17. Total (N = 25,686) Secondary Prevention (n = 19,069) Primary Prevention (n = 6617) Use of Risk-Reducing Medications in the US – Overall Population 81.7 79.1 76.5 76.7 76.5 77.1 75.3 67.9 65.6 65.3 61.6 57.4 Patients (%) 50.4 Antiplatelet Agent Statin ACE-I/ARB β-Blocker ≥3 of 4 (2° Prev) ≥2 of 3 (1° Prev) • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  18. Northeast (n = 3462) Midwest (n = 4786) South (n = 7353) West (n = 3267) Use of Risk-Reducing Medications in the Secondary Prevention Population – Stratified by US Census Region 83.0 82.3 81.0 81.1 80.6 77.4 75.2 75.0 70.7 66.4 66.4 65.6 64.7 64.7 64.7 63.7 63.4 58.9 Patients (%) 55.2 52.9 Antiplatelet Agent Statin ACE-I/ARB β-Blocker ≥3 of 4 (2° Prev) • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  19. Northeast (n = 1313) Midwest (n = 1481) South (n = 2512) West (n = 1240) Use of Risk-Reducing Medications in the Primary Prevention Population – Stratified by US Census Region 80.5 79.7 79.7 78.2 78.9 77.5 77.3 76.0 75.4 75.0 74.9 74.7 62.4 62.2 62.1 59.1 Patients (%) Antiplatelet Agent Statin ACE-I/ARB ≥2 of 3 (1° Prev) • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  20. General Practitioner (n = 8352) Internist (n = 8615) Cardiologist (n = 2254) Endocrinologist (n = 529) Other (n = 951) Use of Risk-Reducing Medications in the Secondary Prevention Population – Stratified by Physician Specialty 84.2 83.7 82.6 81.8 81.0 78.8 79.1 77.1 73.9 74.3 74.2 70.0 70.2 68.3 66.7 66.0 66.2 64.3 62.9 56.7 57.5 56.0 55.2 52.5 51.6 Patients (%) β-Blocker Antiplatelet Agent Statin ACE-I/ARB ≥3 of 4 (2° Prev) • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  21. General Practitioner (n = 3310) Internist (n = 3096) Cardiologist (n = 147) Endocrinologist (n = 311) Other (n = 298) Use of Risk-Reducing Medications in the Primary Prevention Population – Stratified by Physician Specialty 82.8 83.0 79.6 80.4 79.7 78.9 79.5 78.1 76.8 76.3 76.3 75.5 74.4 74.5 71.3 61.5 61.9 61.2 60.2 57.1 Patients (%) Antiplatelet Agent Statin ACE-I/ARB ≥2 of 3 (1° Prev) • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  22. Baseline Predictors for Use of ≥3 of 4 Medication Classes in the US Secondary Prevention Population OR, 4.59; P < 0.0001 OR, 1.76; P < 0.0001 OR, 1.62; P < 0.0001 OR, 1.55; P < 0.0001 OR, 1.40; P < 0.0001 OR, 1.27; P < 0.0001 OR, 1.22; P = 0.0029 OR, 1.22; P = 0.0072 OR, 1.19; P < 0.0001 OR, 1.14; P = 0.0063 OR, 1.13; P = 0.0044 OR, 0.79; P = 0.0095 OR, 0.86; P = 0.0014 OR, 0.86; P = 0.0001 OR, 0.82; P < 0.0001 OR, 0.81; P < 0.0001 OR, 0.78; P = 0.0060 OR, 0.71; P < 0.0001 OR, 0.68; P < 0.0001 OR, 0.60; P < 0.0001 • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  23. Conclusions • Guideline-recommended primary and secondary preventive therapies were underused across US census regions and physician specialties • Among US Census regions, patients in the Northeast showed the highest use of preventive medication use, the South the lowest • Among physician specialties, cardiologists showed the highest prescription of preventive medication use • To improve use of guideline-recommended primary and secondary prevention, novel physician- and patient-centered approaches may be necessary • Kumar A et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(3).

  24. The REACH Registry is sponsored jointly by Participating organizations and endorsed by

  25. For further information on theREACH Registry go to: http://www.REACHRegistry.org

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