Welcome to this learning activity titled A Chest Pain M.I. Registry Overview. After participating in this learning activity, the learner will be able to define the purpose of the chest pain M.I. registry, describe registry inclusion populations and the role of registry governance, and identify harmonization between registry and accreditation programs. The chest pain M.I. registry, which was formerly known as the Action Registry, was created in 2007 to provide a national surveillance system to assess the characteristics, treatments, and outcomes of patients diagnosed with acute myocardial infarction, or AMI. Past registries which documented patterns of care for ACS patients included NRMI, the National Registry of Myocardial Infarction, and Crusade. Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of ACC AHA guidelines? Demonstrated that guideline adherence is suboptimal for a large portion of AMI patients. Despite targeted quality improvement efforts within these registries, treatment patterns for many high-risk subgroups of patients remained suboptimal and treatment disparities persisted. Pre-hospital elements were added to the registry in 2010. Effective June 26, 2018, the American College of Cardiology changed the name of the Action Registry to the Chest Pain M.I. Registry. The new name aligns with the NCDR and Accreditation Service offerings to address additional patient populations. The populations include in-hospital STS-elevation myocardial infarction, known as STEMI, as well as unstable angina and low-risk chest pain. Additionally, through an expanded scope, the Chest Pain M.I. Registry continues to serve the primary aims of the Action Registry while also providing additional opportunities. The registry will reduce variations in care through risk stratification and evaluation of hospital performance in delivering guideline-recommended care and treatments for low-risk chest pain and unstable angina patients, as well as the acute myocardial infarction population. In addition, the Chest Pain M.I. Registry now offers opportunities for collaboration across the multiple providers who play an important role in managing care for these patients, including emergency department clinicians and emergency medical services providers. Coronary artery disease, CAD, is a condition that leads to serious health complications, including AMI and cardiac death. A ruptured plaque in a coronary artery can lead to clot formation within the artery that disrupts blood flow and causes damage to the heart muscle. Because the heart muscle is not receiving enough supply of blood, this can lead to acute myocardial ischemia, otherwise known as a heart attack. Acute coronary syndrome, ACS, has evolved as a useful operational term that refers to a spectrum of conditions compatible with acute myocardial ischemia and or infarction that are usually due to an abrupt reduction in coronary blood flow. It can also refer to any of the clinical conditions that arise because of acute myocardial ischemia, including ST-segma elevation, myocardial infarction, or STEMI, and non-ST-segma elevation myocardial infarction in STEMI, and unstable angina, UA. These life-threatening disorders are a major cause of emergency medical care and hospitalization in the United States. Despite declines in overall mortality rates for CAD, this in part reflects the shift in the pattern of clinical presentations of AMI. Although there has been a marked decline in primary STEMI presentation in the past decade, life-threatening ACS is a major cause of emergency medical care and hospitalization in the United States. An estimated 7 million patients present to the ED annually for chest pain and related symptoms. In 2018, the American Heart Association Heart Disease and Stroke Statistics reported 957,000 unique inpatient hospital discharges for acute myocardial infarction and 1,339,000 for ACS. ACS is also a major source of disability and lost productivity, estimated at nearly 7,500 per disability claim. AMI patients who survived the initial event have substantial risk for future cardiovascular events including recurrent MI, death, heart failure, and stroke. The ACC AHA guidelines for the management of AMI patients, inclusive of both STEMI and NSTEMI, define evidence-based diagnostic and treatment strategies and provide a framework for the use of evidence-based interventions designed to improve outcomes and extend the life expectancy of these patients. There's a strong evidence, however, that indicates the best treatments and strategies are not always utilized. In 2018, the National Center for Health Statistics reported heart disease as the leading cause of death, representing 23% of total deaths in 2016. For more than a decade, the Chest Pain MI Registry, formerly the ACTION Registry, has been the single most trusted source for outcomes-based, continuous quality improvement focus on acute myocardial infarction patients. The registry currently has 1.5 million episode records to facilitate benchmarking of hospital data to performance-based on evidence-based guideline recommendations and performance and quality measures. The Chest Pain MI Registry is designed to create a national surveillance system to assess the characteristics, treatments, and outcomes of patients diagnosed with acute coronary syndrome. These are inclusive of acute myocardial infarction AMI patients. The primary aims of the registry are to optimize the outcomes and management of patients with AMI through the implementation of evidence-based guideline recommendations and clinical practice, to facilitate local hospital efforts to improve the quality and safety of AMI care, and investigate novel quality improvement methods, as well as to provide risk-adjusted assessment of patients for comparison with national data. The 2017 AHA-ACC Clinical Performance and Quality Measures for Adults with ST-Elevation and Non-ST-Elevation Myocardial Infarction provide the foundation for measurement of hospital performance based on process and outcomes of care. The registry focuses on measurement of meaningful processes of care which demonstrate positive impact on patient outcomes. This includes provider and hospital adherence to evidence-based guidelines and avoidance of in-hospital clinical events which may adversely impact patient outcomes. Participants are provided access to their data and their metric performance through an interactive dashboard refresh weekly and quarterly benchmarked feedback through the published outcomes reports. With the launch of the Chest Pain AMI Registry Version 3, which occurred in 2019, in addition to the pre-arrival and the in-hospital STEMI and the NSTEMI, the registry now includes a broader scope of patient populations for low-risk and unstable angina patients. The data is intended to assist hospitals with reducing variations in care through risk stratification and evaluation of hospital performance in delivering guideline-recommended care measures. Acute myocardial infarction definitions for STEMI and NSTEMI follow the fourth universal definition of myocardial infarction, which was published in 2018. This definition includes the detection of rise and or fall of lab-resulted cardiac biomarkers with at least one value above the 99th percentile upper reference limit and at least one of the following two factors. Symptoms of myocardial ischemia or new or presumed new significant ST-segment T-wave changes in two contiguous 12-lead EKG leads or a new left bundle branch block. The broader scope of the registry now includes low-risk and unstable angina patients and this provides hospitals with greater flexibility of which patient populations to include. Unstable angina and low-risk chest pain populations provide a complete source for clinical data reporting in support of hospitals pursuing chest pain center accreditation. In addition, these two patient populations are also eligible for data sampling. Sampling is the process of selecting a representative portion of the population of interest as means to estimate the hospital's overall performance. With a statistically valid sample, a hospital can efficiently and effectively measure performance. The registry provides a single data source with streamlined data entry, monitoring, and trending for the purposes of the ACC's Chest Pain Center Accreditation Program. Collaborative options for the wider CV team, including pre-hospital providers, EMTs, ER providers, and others caring for at-risk patients with chest pain and acute myocardial infarction. The registry can also meet the state requirements that have adopted the chest pain in my registry as their state-level measurement and reporting source. This can significantly minimize data capture burden for hospitals participating in the registry. Through this harmonization, the ACC NCDR will also generate new knowledge on treatment patterns and patient outcomes for the low-risk and unstable angina patients, thereby contributing to ACC's mission to provide trusted, real-world evidence to members through research. The chest pain in my registry is governed by a 7-10 member steering committee with a chair and ex-officio member of the NCDR Oversight Committee. Committee members have expertise in clinical practice, financial management, quality measurement, and improvement and or health system strategy and innovation. The steering committee provides strategic oversight and direction. Guidance for program activities and research insights help to identify priorities. Committee recommendations are then provided to the NCDR Oversight Committee and help inform this committee's decisions. The Chest Pain in My Registry Performance Achievement Award Program recognizes hospitals participating in chest pain in my registry who've demonstrated sustained, top-level performance in quality of care and adherence to guideline recommendations. Through full participation in the registry, hospitals engage in a robust quality improvement process using data to drive improvements and positively impact patient outcomes for heart attack patients. Award recipients are recognized for their consistency in meeting patient care guidelines for AMI patients, and hospitals are evaluated for eligibility at the Platinum, Gold, and Silver award levels. Hospitals that receive a Performance Achievement Award are featured in the special U.S. News and World Report Best Hospitals Issue. Additionally, each facility's award status is displayed on the ACC's Find Your Heart a Home Hospital profile page on CardioSmart.org. Thank you for participating in this learning activity titled A Chest Pain in My Registry Overview. Now that this learning activity is completed, the learner will be able to define the purpose of the chest pain in my registry, describe registry inclusion populations and the role of registry governance, and identify harmonization between registry and accreditation programs.

Chest Pain M.I. Registry

Action Registry

acute myocardial infarction

registry

hospital performance