Stable Ischemic Heart Disease A1627 JACC April 1, 2014 Volume 63, Issue 12 EDUCATIONAL PROGRAM FOR REDUCING INAPPROPRIATE PERCUTANEOUS CORONARY INTERVENTION: A REAL-WORLD EXPERIENCE AT A TERTIARY CARE INSTITUTION Poster Contributions Hall C Monday, March 31, 2014, 9:45 a.m.-10:30 a.m. Session Title: Invasive Angiography and Revascularization Strategies in Stable Ischemic Heart Disease Abstract Category: 25. Stable Ischemic Heart Disease: Clinical Presentation Number: 1269-334 Authors: Michael Anigbogu, Krishna Nagendran, Rayan Yousefzai, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta, Aurora Cardiovasc Svcs, Aurora Sinai/St. Luke’s Med Ctrs, Univ Wisconsin Sch Med and Public Health, Milwaukee, WI, USA Background: Analyses of the National Cardiovascular Data Registry’s CathPCI® database have shown inappropriate percutaneous coronary intervention (PCI) mostly occurs in nonacute procedures and incidence ranges from 0-55%. It has been reported that more than 80% of all inappropriate PCIs are confined to five clinical scenarios: patients with 1) prior coronary artery bypass graft; 2) one- or two-vessel disease without proximal left anterior descending artery involvement; 3) low Canadian Cardiovascular Society symptom class; 4) low to intermediate cardiac risk based on stress test; or 5) suboptimal antianginal therapy. We sought to evaluate the effect of in-house educational and periprocedural tools on adherence to appropriate use criteria (AUC) for coronary revascularization. Methods: A set of tools addressing the previously identified weaknesses of AUC adherence in PCI was prospectively implemented in April 2012 and tracked through September 2013. The first tool was a lecture to interventionalists, fellows and catheterization staff. Secondly, electronic and paper documents addressing three key areas, optimal medical therapy, severity of angina and severity of stress test findings, were distributed. These steps were carried out prior to procedure in patients undergoing nonurgent PCI as well as during the timeout period. Providers were encouraged to use the SCAI Quality Improvement Toolkit on their portable devices during PCI. Finally, a quarterly progress report was provided to each interventionalist. Incidence of inappropriate PCI before and after implementation of these tools was measured. Results: We found a 39% decrease in inappropriate PCI from the second quarter of 2012 (pre-tool implementation) to the fourth quarter of 2013. In addition, there was a 63% increase in appropriate PCI procedures performed. Total PCI volume did not change significantly. Conclusion: Implementing these educational and documentation tools led to a substantial decrease in the number of inappropriate PCI at our institution as well as more patients being appropriately revascularized via PCI. Based on these findings, we are currently implementing these tools to other hospitals in our health care system.

EDUCATIONAL PROGRAM FOR REDUCING INAPPROPRIATE PERCUTANEOUS CORONARY INTERVENTION: A REAL-WORLD EXPERIENCE AT A TERTIARY CARE INSTITUTION

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Page 1: EDUCATIONAL PROGRAM FOR REDUCING INAPPROPRIATE PERCUTANEOUS CORONARY INTERVENTION: A REAL-WORLD EXPERIENCE AT A TERTIARY CARE INSTITUTION

Stable Ischemic Heart Disease

A1627JACC April 1, 2014

Volume 63, Issue 12

edUcational Program for redUcing inaPProPriate PercUtaneoUs coronary intervention: a real-World exPerience at a tertiary care institUtion

Poster ContributionsHall CMonday, March 31, 2014, 9:45 a.m.-10:30 a.m.

Session Title: Invasive Angiography and Revascularization Strategies in Stable Ischemic Heart DiseaseAbstract Category: 25. Stable Ischemic Heart Disease: ClinicalPresentation Number: 1269-334

Authors: Michael Anigbogu, Krishna Nagendran, Rayan Yousefzai, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta, Aurora Cardiovasc Svcs, Aurora Sinai/St. Luke’s Med Ctrs, Univ Wisconsin Sch Med and Public Health, Milwaukee, WI, USA

Background: Analyses of the National Cardiovascular Data Registry’s CathPCI® database have shown inappropriate percutaneous coronary intervention (PCI) mostly occurs in nonacute procedures and incidence ranges from 0-55%. It has been reported that more than 80% of all inappropriate PCIs are confined to five clinical scenarios: patients with 1) prior coronary artery bypass graft; 2) one- or two-vessel disease without proximal left anterior descending artery involvement; 3) low Canadian Cardiovascular Society symptom class; 4) low to intermediate cardiac risk based on stress test; or 5) suboptimal antianginal therapy. We sought to evaluate the effect of in-house educational and periprocedural tools on adherence to appropriate use criteria (AUC) for coronary revascularization.

methods: A set of tools addressing the previously identified weaknesses of AUC adherence in PCI was prospectively implemented in April 2012 and tracked through September 2013. The first tool was a lecture to interventionalists, fellows and catheterization staff. Secondly, electronic and paper documents addressing three key areas, optimal medical therapy, severity of angina and severity of stress test findings, were distributed. These steps were carried out prior to procedure in patients undergoing nonurgent PCI as well as during the timeout period. Providers were encouraged to use the SCAI Quality Improvement Toolkit on their portable devices during PCI. Finally, a quarterly progress report was provided to each interventionalist. Incidence of inappropriate PCI before and after implementation of these tools was measured.

results: We found a 39% decrease in inappropriate PCI from the second quarter of 2012 (pre-tool implementation) to the fourth quarter of 2013. In addition, there was a 63% increase in appropriate PCI procedures performed. Total PCI volume did not change significantly.

conclusion: Implementing these educational and documentation tools led to a substantial decrease in the number of inappropriate PCI at our institution as well as more patients being appropriately revascularized via PCI. Based on these findings, we are currently implementing these tools to other hospitals in our health care system.