CVD Prevention Guidelines: Design and Implementation

Nathan D. Wong, PhD, FACC, FAHA Professor and Director Heart Disease Prevention Program Division of Cardiology University of California, Irvine, CA USA President, American Society for Preventive Cardiology

Scientific Statements
- increase knowledge and awareness by healthcare professionals of effective, stateof-the art science related to the causes, prevention, detection, or management of cardiovascular diseases and stroke. - represent the consensus of the leading experts in cardiovascular disease and stroke. - undergo blinded peer review and are reviewed and approved by the AHA Science Advisory and Coordinating Committee (SACC), the highest scientific body of the AHA.
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Guidelines
The Institute of Medicine defines a guideline as systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. The AHA often develops practice guidelines in conjunction with the American College of Cardiology (ACC), but also may develop them alone or in partnership with other organizations as appropriate. All guidelines adhere to the levels of evidence and classes of recommendation as established by the ACC/AHA Guidelines Task Force. All guidelines undergo peer review and are reviewed and approved by the AHA SACC.
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Overview of AHA CVD Prevention Guidelines

Diet and Lifestyle Recommendations: Revision 2006 AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack American Heart Association Guide for Improving Cardiovascular Health at the Community Level AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update Heart Association Guidelines for Weight Management Programs for Healthy Adults
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Overview of ACCF/AHA Performance Measurement Sets

Attributes of Performance Measures

Classification of Recommendations and Levels of Evidence

Applying Classification of Recommendations and Level of Evidence

Class I Benefit >>> Risk Class IIa Benefit >> Risk Additional studies with focused objectives needed Class IIb Benefit Risk Additional studies with broad objectives needed; Additional registry data would be helpful Procedure or treatment MAY BE CONSIDERED Class III Risk Benefit No additional studies needed

Procedure or treatment SHOULD be performed or administered

IT IS REASONABLE to perform procedure or administer treatment

Procedure or treatment should NOT be performed or administered SINCE IT IS NOT HELPFUL AND MAY BE HARMFUL

Applying Classification of Recommendations and Level of Evidence

Level A
Multiple (3-5) population risk strata evaluated General consistency of direction and magnitude of effect

Class I
Recommendation that procedure or treatment is useful/ effective Sufficient evidence from multiple randomized trials or metaanalyses

Class IIa
Recommendation in favor of treatment or procedure being useful/ effective Some conflicting evidence from multiple randomized trials or metaanalyses

Class IIb
Recommendation s usefulness/ efficacy less well established Greater conflicting evidence from multiple randomized trials or metaanalyses

Class III
Recommendation that procedure or treatment not useful/ effective and may be harmful

Sufficient evidence from multiple randomized trials or metaanalyses

Applying Classification of Recommendations and Level of Evidence

Level B
Limited (2-3) population risk strata evaluated

Class I
Recommendation that procedure or treatment is useful/ effective Limited evidence from single randomized trial or nonrandomized studies

Class IIa
Recommen-dation in favor of treatment or procedure being useful/ effective Some conflicting evidence from single randomized trial or nonrandomized studies

Class IIb
Recommendations usefulness/ efficacy less well established Greater conflicting evidence from single randomized trial or nonrandomized studies

Class III
Recommen-dation that procedure or treatment not useful/effective and may be harmful Limited evidence from single randomized trial or nonrandomized studies

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Applying Classification of Recommendations and Level of Evidence

Level C
Very limited (1-2) population risk strata evaluated

Class I
Recommendation that procedure or treatment is useful/ effective Only expert opinion, case studies, or standard-ofcare

Class IIa
Recommendation in favor of treatment or procedure being useful/effective Only diverging expert opinion, case studies, or standard-of-care

Class IIb
Recommendations usefulness/ efficacy less well established Only diverging expert opinion, case studies, or standard-of-care

Class III
Recommendation that procedure or treatment not useful/effective and may be harmful Only expert opinion, case studies, or standard-of-care

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AHA / ACCF Primary Prevention Revised Statement September 2009

Circulation, September 2009

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Lifestyle / Risk Factor Screening

Numerator = Patients with assessment of diet and physical activity occurred in the past 2 years Denominator = Patients aged 8-80 years at beginning of assessment period
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Dietary Intake Counseling

Numerator = Patients who were advised to eat a healthy diet at least once in the past 2 years Denominator All patients 18 to 80 years of age at start of the measurement period

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AHA Scientific Statement: Diet and Lifestyle Recommendations Revision 2006

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Physical Activity Counseling

Numerator = Patients who were advised at least once within the past 2 years to engage in regular physical activity Denominator All patients 18 to 80 years of age at start of the measurement period

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Smoking / Tobacco Use

Numerator = Patients who were queried about tobacco use 1 or more times in the past 2 years
Denominator All patients 18 years of age or over at start of the measurement period
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Smoking / Tobacco Cessation

Numerator = Patients identified as tobacco users who received cessation intervention Denominator = All patients aged 18 years and over at start of measurement period identified as tobacco 19 users

Weight / Adiposity Assessment

Numerator = Patients for whom weight and BMI and/or WC is documented at least once in the last 2 years Denominator = All patients 18-80 years of age at start of measurement period
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Weight Management

Numerator = All patients who were counseled on weight management at least once within the past 2 years
Denominator = All patients 18-80 years of age at start of measurement period with BMI >30 or WC >102 cm (men) or >88 cm (women)

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Blood Pressure Measurement

Numerator = Patients for whom blood pressure measurement was recorded at least once in the past 2 years Denominator = All patients aged 18-80 years at
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Blood Pressure Control

Numerator: Patients aged 18-80 years of age with HTN who had a recorded BP reading <140/90 mmHg or who were prescribed 2+ medications Denominator: Patients with HTN diagnosed for at least 6 months

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Blood Lipid Measurement

Numerator = Patients with at least 1 fasting lipid profile performed within the past 5 years
Denominator = Men aged 35-80 or Women aged 45-80 with at least 1 risk factor, 2+ visits

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Blood Lipid Therapy and Control

Numerator = Patients whose most recent LDL-C (mg/dl) was <190 (<10% risk women), <160 (<10% low risk men), <130 (10-20% risk), <100 (>20% risk), or prescribed maximal lipid therapy Denominator = Patients with a fasting lipid profile and risk assessment
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Global Risk Estimation

Numerator (quality improvement only): patients for whom 10-year risk of CHD is recorded at least once in the last 5 years
Denominator: Men aged 35-80 and women 45-80 free of CHD but with at least one risk factor
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Aspirin use

Numerator ( internal quality improvement only): men aged 35-80 or women 45-80 advised to use aspirin
Denominator: All men 35-80 or women 45-80 without CVD but with estimated 10-year CHD risk >=20%

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AHA Secondary Prevention for Patients with Coronary Artery and Other Atherosclerotic Vascular Disease

Circulation 2006;113:2363-2372 and J Am Coll Cardiol 2006;47:2130-2139

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Introduction
Since the 2001 update of the AHA/ACC consensus statement on secondary prevention, important evidence from clinical trials has emerged that further supports and broadens the merits of aggressive risk reduction therapies This growing body of evidence confirms that aggressive comprehensive risk factor management improves survival, reduces recurrent events and the need for interventional procedures, and improves the quality of life The secondary prevention patient population includes those with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease and carotid artery disease.
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Secondary Prevention Definition

Therapy to reduce recurrent cardiovascular events and decrease cardiovascular mortality in patients with established atherosclerotic vascular disease Patients covered include those with established coronary and other atherosclerotic vascular disease, including peripheral arterial disease, atherosclerotic aortic disease and carotid artery disease Individuals with sub-clinical atherosclerosis and patients whose only manifestation is diabetes are covered in other guidelines
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Components of Secondary Prevention

Cigarette smoking cessation Blood pressure control Lipid management to goal Physical activity Weight management to goal Diabetes management to goal Antiplatelet agents / anticoagulants Renin angiotensin aldosterone system blockers Beta blockers Influenza vaccination

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Evidence Based Therapies

The writing group emphasizes the importance of giving consideration to the use of cardiovascular medications that have been proven to be of benefit in randomized clinical trials.

This approach strengthens the evidence-based foundation for therapeutic application of these guidelines. The committee acknowledges that in many trials there is under-representation of ethnic minorities, women, and the elderly.
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Cigarette Smoking Recommendations

Goal: Complete Cessation and No Exposure to Environmental Tobacco Smoke
Ask about tobacco use status at every visit. Advise every tobacco user to quit. Assess the tobacco users willingness to quit.
I IIa IIb III

Assist by counseling and developing a plan for quitting. Arrange follow-up, referral to special programs, or pharmacotherapy (including nicotine replacement and bupropion. Urge avoidance of exposure to environmental tobacco smoke at work and home.

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Blood Pressure Control Recommendations

Goal: <140/90 mm Hg or <130/80 if diabetes or chronic kidney disease
I IIa IIb III

Blood pressure 120/80 mm Hg or greater: Initiate or maintain lifestyle modification: weight control, increased physical activity, alcohol moderation, sodium reduction, and increased consumption of fresh fruits vegetables and low fat dairy products Blood pressure 140/90 mm Hg or greater (or 130/80 or greater for chronic kidney disease or diabetes) As tolerated, add blood pressure medication, treating initially with beta blockers and/or ACE inhibitors with addition of other drugs such as thiazides as needed to achieve goal blood pressure
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I IIa IIb III

Lipid Management Goal

I IIa IIb III

LDL-C should be less than 100 mg/dL

I IIa IIb III

Further reduction to LDL-C to < 70 mg/dL is reasonable

If TG >200 mg/dL, non-HDL-C should be < 130 mg/dL*

*Non-HDL-C = total cholesterol minus HDL-C

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Lipid Management Goals: NCEP

Consider Drug Therapy

Risk Category

LDL-C and nonHDL-C Goal <100 mg/dL if TG > 200 mg/dL, non-HDL-C should be < 130 mg/dL <70 mg/dL, non-HDL-C < 100 mg/dL

Initiate TLC 100 mg/dL

High risk: CHD or CHD risk equivalents (10-year risk >20%) and Very high risk: ACS or established CHD plus: multiple major risk factors (especially diabetes) or severe and poorly controlled risk factors

>100 mg/dL (<100 mg/dL: consider drug options)

All patients

>100 mg/dL (<100 mg/dL: consider drug options)

ATP=Adult Treatment Panel, CHD=Coronary heart disease, LDL-C=Low-density lipoprotein cholesterol, TLC=Therapeutic lifestyle changes Grundy, S. et al. Circulation 2004;110:227-39.

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Lipid Management Recommendations

For all patients
I IIa IIb III

Start dietary therapy (<7% of total calories as saturated fat and <200 mg/d cholesterol) Adding plant stanol/sterols (2 gm/day) and viscous fiber (>10 mg/day) will further lower LDL
I IIa IIb III

I IIa IIb III

Promote daily physical activity and weight management. Encourage increased consumption of omega-3 fatty acids in fish or 1 g/day omega-3 fatty acids in capsule form for risk reduction.
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ATP III Dietary Recommendations

Nutrient Saturated fat* Recommended Intake <7% of total calories

Polyunsaturated fat Monounsaturated fat

Total fat Carbohydrate (esp. complex carbs) Fiber Protein Cholesterol

Up to 10% of total calories Up to 20% of total calories

25%35% of total calories 50%60% of total calories 2030 g/d ~15% of total calories <200 mg/d

*Trans fatty acids also raise LDL-C and should be kept at a low intake. Note: Regarding total calories, balance energy intake and expenditure to maintain desirable body weight.
ATP=Adult Treatment Panel Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497.

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Lipid Management Recommendations

Assess fasting lipid profile in all patients, and within 24 hours of hospitalization for those with an acute event. For patients hospitalized, initiate lipid-lowering medication as recommended below prior to discharge according to the following schedule:

I IIa IIb III

If baseline LDL-C > 100 mg/dL, initiate LDLlowering drug therapy

I IIa IIb III

If on-treatment LDL-C > 100 mg/dL, intensify LDL-lowering drug therapy (may require LDL lowering drug combination) If baseline is LDL-C 70 to 100 mg/dL, it is reasonable to treat to LDL < 70 mg/dL

I IIa IIb III

When LDL lowering medications are used, obtain at least a 30-40% reduction in LDL-C levels.

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Lipid Management Recommendations

I IIa IIb III

If TG are 200-499 mg/dL, non-HDL-C should be < 130 mg/dL

I IIa IIb III

Further reduction of non-HDL to < 100 mg/dL is reasonable

Therapeutic options to reduce non-HDL-C: More intense LDL-C lowering therapy I (B) or Niacin (after LDL-C lowering therapy) IIa (B) or Fibrate (after LDL-C lowering therapy) IIa (B)

I IIa IIb III

If TG are > 500 mg/dL, therapeutic options to prevent pancreatitis are fibrate or niacin before LDL lowering therapy; and treat LDL-C to goal after TG-lowering therapy. Achieve non-HDL-C < 130 mg/dL, if possible
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Physical Activity Recommendations

Goal: 30 minutes 7 days/week, minimum 5 days/week
I IIa IIb III

Assess risk with a physical activity history and/or an exercise test, to guide prescription
I IIa IIb III

Encourage 30 to 60 minutes of moderate intensity aerobic activity such as brisk walking, on most, preferably all, days of the week, supplemented by an increase in daily lifestyle activities Advise medically supervised programs for high-risk patients (e.g. recent acute coronary syndrome or revascularization, HF)
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I IIa IIb III

Weight Management Recommendations

Goal: BMI 18.5 to 24.9 kg/m2 Waist Circumference: Men: < 40 inches Women: < 35 inches
I IIa IIb III
Assess BMI and/or waist circumference on each visit and consistently encourage weight maintenance/ reduction through an appropriate balance of physical activity, caloric intake, and formal behavioral programs when indicated.

I IIa IIb III

If waist circumference (measured at the iliac crest) >35 inches in women and >40 inches in men initiate lifestyle changes and consider treatment strategies for metabolic syndrome as indicated. The initial goal of weight loss therapy should be to reduce body weight by approximately 10 percent from baseline. With success, further weight loss can be attempted if indicated.
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I IIa IIb III

*BMI is calculated as the weight in kilograms divided by the body surface area in meters2. Overweight state is defined by BMI=25-30 kg/m2. Obesity is defined by a BMI >30 kg/m2.

Diabetes Mellitus Recommendations

Goal: Hb A1c < 7%

I IIa IIb III

Lifestyle and pharmacotherapy to achieve near normal HbA1C (<7%).

I IIa IIb III

Vigorous modification of other risk factors (e.g., physical activity, weight management, blood pressure control, and cholesterol management as recommended). Coordinate diabetic care with patients primary care physician or endocrinologist. )

I IIa IIb III

HbA1c = Glycosylated hemoglobin

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Antiplatelet Agents / Anticoagulation Recommendations

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Aspirin Recommendations
I IIa IIb III

Start and continue indefinitely aspirin 75 to 162 mg/d in all patients unless contraindicated For patients undergoing CABG, aspirin (100 to 325 mg/d) should be started within 48 hours after surgery to reduce saphenous vein graft closure Post-PCI-stented patients should receive 325 mg per day of aspirin for 1 month for bare metal stent, 3 months for sirolimus-eluting stent and 6 months for paclitaxel-eluting stent
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I IIa IIb III

I IIa IIb III

Clopidogrel Recommendations

Start and continue clopidogrel 75 mg/d in combination with aspirin

I IIa IIb III

for post ACS or post PCI with stent placement patients for up to 12 months for post PCI-stented patients >1 month for bare metal stent, >3 months for sirolimus-eluting stent >6 months for paclitaxel-eluting stent

*Clopidogrel is generally given preference over Ticlopidine because of a superior safety profile

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Anticoagulation Recommendations

I IIa IIb III

Manage warfarin to international normalized ratio 2.0 to 3.0 for paroxysmal or chronic atrial fibrillation or flutter, and in post-MI patients when clinically indicated (e.g., atrial fibrillation, LV thrombus.)

I IIa IIb III

Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with increased risk of bleeding and should be monitored closely

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Renin-Angiotensin-Aldosterone System Blockers Recommendations

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ACE Inhibitor Recommendations

I IIa IIb III

Use in all patients with LVEF < 40%, and those with diabetes or chronic kidney disease indefinitely, unless contraindicated
I IIa IIb III

Consider for all other patients

I IIa IIb III

Among lower risk patients with normal LVEF where cardiovascular risk factors are well controlled and where revascularization has been performed, their use may be considered optional

ACE=Angiotensin converting enzyme, LVEF= left ventricular ejection fraction

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Angiotensin Receptor Blocker Recommendations

I IIa IIb III

I IIa IIb III

Use in patients who are intolerant of ACE inhibitors with HF or post MI with LVEF less than or equal to 40%. Consider in other patients who are ACE inhibitor intolerant.

I IIa IIb III

Consider use in combination with ACE inhibitors in systolic dysfunction HF.

ACE=Angiotensin converting enzyme inhibitor, LVEF=Left Ventricular Ejection fraction, HF=Heart failure, MI=Myocardial infarction

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Aldosterone Antagonist Recommendations

I IIa IIb III

Use in post MI patients, without significant renal dysfunction or hyperkalemia, who are already receiving therapeutic doses of an ACE inhibitor and beta blocker, have an LVEF < 40% and either diabetes or heart failure

*Contraindications include abnormal renal function (creatinine >2.5 mg/dL in men or >2.0 mg/dL in women) and hyperkalemia (K+ >5.0 meq/L)

ACE=Angiotensin converting enzyme inhibitor, LVEF=Left Ventricular Ejection fraction, MI=Myocardial infarction

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b-blocker Recommendations

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b-blocker Recommendations
I IIa IIb III

Start and continue indefinitely in all post MI, ACS, LV dysfunction with or without HF symptoms, unless contraindicated. Consider chronic therapy for all other patients with coronary or other vascular disease or diabetes unless contraindicated.

I IIa IIb III

*Precautions but still indicated include mild to moderate asthma or chronic obstructive pulmonary disease, insulin dependent diabetes mellitus, severe peripheral arterial disease, and a PR interval >0.24 seconds.

MI=Myocardial infarction, HF=Heart Failure

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Influenza Vaccination

I IIa IIb III

Patients with cardiovascular disease should have influenza vaccination

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The Need to Implement Secondary Prevention

Multiple studies of the use of these recommended therapies in appropriate patients continue to show that many patients in whom therapies are indicated are not receiving them in actual clinical practice. The AHA and ACC urge that in all medical care settings where these patients are managed that programs to provide practitioners with useful reminder clues based on the guidelines, and continuously assess the success achieved in providing these therapies to the patients who can benefit from them be implemented. Encourage that the AHAs Get With the Guidelines and/or ACCs Guidelines Applied to Practice Programs be instituted to identify appropriate patients for therapy

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AHA GWTG Program

GWTG is a national initiative of the AHA to improve guidelines adherence in patients hospitalized with cardiovascular disease. GWTG uses collaborative learning sessions, conference calls, e-mail and staff support to assist hospital teams improve acute and secondary prevention care systems. A web-based Patient Management Tool is used for point of care data collection and decision support, on-demand reporting, communication and patient education.

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SIMPLE, ONE PAGE, ON-LINE FORM

Demographics 6 clicks Clinical/Lab 8 clicks

Interactively checks patients data with the AHA guidelines

Discharge meds and interventions 7 clicks

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2001 Outcome Sciences, Inc.

Impact of AHA Get With The Guidelines-CAD Program on Quality of Care

Baseline 100 90 80 70 60 50 40 30 20 10 0 Q1 Q2 Q3 Q4

* 97 9796 95 93
83 79

8787

* * * 91
*
64656567 68

* p< 0.05 compared to baseline

73 6770

* * * 75

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70 57

* 7675

* * * 82

Aspirin

Beta Blocker ACE Inhibitor

Lipid Rx

Smoking Cessation

GWTG-CAD: 123 US Hospitals n=27,825 Labresh, Fonarow et al. Circulation 2003;108:IV-722

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Secondary Prevention Conclusions

Evidence confirms that aggressive comprehensive risk factor management improves survival, reduces recurrent events and the need for interventional procedures, and improves the quality of life for these patients.
Every effort should be made to ensure that patients are treated with evidence-based, guideline recommended, life-prolonging therapies in the absence of contraindications or intolerance.

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Issue/Challenge Patients hospitalized with cardiovascular event are at particularly high risk for recurrent events, hospitalizations, and cardiovascular death. Fortunately, there are a number of evidence based and highly effective therapies which can significantly improve acute long-term care outcomes and reduce recurrent events.

While the AHA, ACC, and ASA Guidelines provide evidence-based recommendations for cardiovascular care, adherence to these guidelines is both incomplete and highly variable.
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AHAs Quality Portfolio

AHA Quality Improvement Programs: Get With The Guidelines-Stroke Get With The Guidelines-Heart Failure ACTION Registry-- GWTG Get With The Guidelines-Outpatient (November 2009) Mission: Lifeline National Registry of CPR Co-promoted programs associated with AHA/ASA Quality programs: NCQA/AHA/ASA Heart and Stroke Recognition Program Disease Specific Care Certification for Primary Stroke Centers (The Joint Commission/AHA/ASA) Advanced Certification in Heart Failure (TJC/AHA)
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GWTG Cumulative Progress through September 8, 2009:

Module
CAD Heart Failure Stroke TOTAL
Source: Siebel Dashboards as of 6/30/09

Contracts
416 431 1318 2165

Patient Records
547,512 287,826 1,006,002 1,978,228
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Get With The Guidelines: Elements of Success

Attend a GWTG workshop Designate a champion from hospital Recruit care team for implementation Enter baseline data into the Patient Management Tool Institute care paths, standing orders and discharge protocols that are consistent with the ASA/AHA guidelines Utilize the Patient Management Tool to record and improve patient care. Achieve Performance Award levels

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How is Health Integration Technology used by GWTG to achieve goals?

Patient Management ToolTM Easy to use, web-based, real-time data management and decision support tool Incorporates proven, decision-support-guideline reminder checks Opportunity for concurrent data collection-access to realtime data collection and report generation to support rapid CQI Automatically generated, patient-specific education materials customized for the patient Core measure reporting options
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AHA GWTG-HF Web Based Patient Management Tool

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Program Progress Reports

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GWTG-CAD: Performance Measures

100.0% 90.0% 80.0% 70.0% 60.0%
Compliance

50.0% 40.0% 30.0% 20.0% 10.0% 0.0% ASA within 24 Hours Baseline Current 82.1% 91.5% ASA at Discharge 83.3% 94.2% Beta Blockers at Discharge 77.9% 94.1% ACEI or ARB at D/C for LVSD 68.8% 92.6%

Lipid Lowering Therapy at D/C for LDL > 100 72.1% 91.6%

Smoking Cessation Counseling 62.6% 98.4%

Composite 100% Performance Measure Compliance Measure 76.9% 92.7% 56.1% 85.8%

Performance Measure

Baseline = Admissions Jan2002 Dec2002 Current = Admissions Jul2008-Jun2009

July 2009

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GWTG-HF: Performance Measures

100.0% 90.0% 80.0% 70.0%
Compliance

60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Discharge Instructions Baseline Current 69.7% 89.5%

LV Function Measurement 90.1% 96.7%

ACEI or ARB at D/C for LVSD 81.2% 91.8%

Beta Blocker at D/C for LVSD 87.3% 92.5% Performance Measure

Smoking Cessation Counseling 77.4% 96.1%

Composite Performance Measure 80.1% 92.5%

100% Compliance Measure 60.1% 83.8%

Baseline = Admissions Jan2005 Dec2005 Current = Admissions Jul2008 Jun2009

July 2009

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GWTG-Stroke: Performance Measures

100.0% 90.0% 80.0% 70.0%
Compliance

60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

tPA < 3hr with Arrival < 2hr after Onset 27.6% 67.5%

Early Antithrombotic 87.9% 96.1%

DVT Risk Management 65.8% 92.8%

Antithrombotic Tx Lipid Lowering Anticoag. Tx at at Therapy at D/C for Discharge for Afib Discharge LDL > 100 92.7% 97.2% 52.9% 93.6% Performance Measure 39.7% 84.0%

Smoking Cessation Counseling 44.3% 95.3%

Composite Performance Measure 70.5% 92.3%

100% Compliance Measure 40.2% 83.0%

Baseline Current

Baseline = Admissions Jan2003 Dec2003 Current = Admissions Jul2008 Jun2009

July 2009

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GWTG Publications
2009 through 8/2/09: 13 Published Manuscripts (4 HF, 5 CAD, 3 Stroke, 1 CAD/HF) 23 Abstracts presented at Conferences (ISC 10, ACC 6, QCOR 7, HFSA 0) Snapshot of GWTG papers in process: 23 Manuscripts: 12 pending Journal decision, 11 in process to Journal submission 18 Abstracts: 8 pending acceptance at AHA 2009 conference, 10 in process to manuscript 32 Total Research Proposals in Queue 2008 Results: 20 Published Manuscripts (5 HF, 10 CAD, 5 Stroke) 2007 Results: 4 Published Manuscripts (1 HF, 3 CAD)
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Future Impact: Advancing Healthcare Largest national hospital-based program dedicated to quality of care improvement for patients with CVD Participating hospitals have demonstrated greater adherence to national guideline-recommended therapies compared to other US hospitals publicly reporting data at the same time (proven framework) With the possibility of such dramatic outcomes, helping healthcare professionals implement guidelines presents a great opportunity to improve the health of patients now and in the future.

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Hvala - Thank you!

For more information contact the UCI Heart Disease Prevention Program at: www.heart.uci.edu 949-824-5561
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