Download - 2006 CRUSADE 2 nd Quarter Results
2006 CRUSADE 22006 CRUSADE 2ndnd Quarter Results Quarter Results
Last updated: 8/1/06
Active sites = 400
AK(0)
WA(5)
OR(6)
CA(33)
ID(0)
NV(3)
MT(0)
WY(0)
CO(9)
NM(1)
ND(1)
SD(2)
NE (2)
KS(3)
OK(5)
TX(16)
MN(3)
IA(6)
MO(9)
AR(2)
LA(6)
WI(7) MI
(21)
MI
UT(1)
AZ(8)
HI (0)
IL(20)
IN(8)
KY(8)
TN(9)
MS(6)
AL(8)
GA(10)
FL(29)
SC(5)
NC(14)
VA(17)
OH(38)
WV(2)
PA(38)
NY(31)
MD (13)
ME(0)
VT (1)
NH (1)
NJ (12)
MA (10)
CT (7)
DE (3)
RI (1)
DC (1)
CRUSADE Site DistributionCRUSADE Site Distribution
CRUSADE Cumulative CRUSADE Cumulative Data Submission (n= 180,842)Data Submission (n= 180,842)
138716
148147156742
165498172763
180842
50000
70000
90000
110000
130000
150000
170000
190000
Mar-05 Jun-05 Sep-05 Dec-05 Mar-06 Jun-06
Baseline Characteristics:Baseline Characteristics:CRUSADE vs. ACS Clinical TrialsCRUSADE vs. ACS Clinical Trials
VariableVariable PURSUITPURSUIT CURECURE SYNERGYSYNERGY CRUSADECRUSADE(n = 9461)(n = 9461) (n = 12,562)(n = 12,562) (n = 9975)(n = 9975) (n = 180,842)(n = 180,842)
Mean age ± SD (yrs)Mean age ± SD (yrs) 63 ± 1163 ± 11 63 ± 1263 ± 12 67 ± 1167 ± 11 67 ± 1467 ± 14
Female sex (%)Female sex (%) 3636 3939 3434 4040
Diabetes mellitus (%)Diabetes mellitus (%) 2323 2323 2929 3333
Prior MI (%)Prior MI (%) 3232 2525 2828 3030
Prior CHF (%)Prior CHF (%) 1111 88 99 1818
Prior PCI (%)Prior PCI (%) 1313 18*18* 2020 2121
Prior CABG (%)Prior CABG (%) 1212 18*18* 1717 1919
ST depression (%)ST depression (%) 5050 4242 5555 3434
NEJM 1998;339:436-43NEJM 1998;339:436-43NEJM 2001;345:494-502NEJM 2001;345:494-502JAMA 2004:292:45-54JAMA 2004:292:45-54CRUSADE cumulative through June 30, 2006CRUSADE cumulative through June 30, 2006
NEJM 1998;339:436-43NEJM 1998;339:436-43NEJM 2001;345:494-502NEJM 2001;345:494-502JAMA 2004:292:45-54JAMA 2004:292:45-54CRUSADE cumulative through June 30, 2006CRUSADE cumulative through June 30, 2006
Hospital PresentationHospital PresentationCharacteristics in CRUSADE – Q2 2006Characteristics in CRUSADE – Q2 2006
Qualifying CriteriaQualifying CriteriaST-segment depressionST-segment depression 27% 27%Transient ST-segment elevationTransient ST-segment elevation 4% 4%Positive cardiac markersPositive cardiac markers 93% 93%
Baseline cardiac markersBaseline cardiac markers DrawnDrawnPositive*Positive*
CK-MBCK-MB 82%82%73%73%TnT/TnITnT/TnI 99%99%85%85%
Presenting CharacteristicsPresenting Characteristics TachycardiaTachycardia 21%21%HypotensionHypotension 4% 4%Signs of CHF 22%Signs of CHF 22%
Qualifying CriteriaQualifying CriteriaST-segment depressionST-segment depression 27% 27%Transient ST-segment elevationTransient ST-segment elevation 4% 4%Positive cardiac markersPositive cardiac markers 93% 93%
Baseline cardiac markersBaseline cardiac markers DrawnDrawnPositive*Positive*
CK-MBCK-MB 82%82%73%73%TnT/TnITnT/TnI 99%99%85%85%
Presenting CharacteristicsPresenting Characteristics TachycardiaTachycardia 21%21%HypotensionHypotension 4% 4%Signs of CHF 22%Signs of CHF 22%*Of subset drawn
Q2 2006 CRUSADE data (n=6923)
Hospital PresentationHospital PresentationCharacteristics in CRUSADE-Characteristics in CRUSADE-
Last 12 MonthsLast 12 Months Qualifying CriteriaQualifying CriteriaST-segment depressionST-segment depression 28% 28%Transient ST-segment elevationTransient ST-segment elevation 5% 5%Positive cardiac markersPositive cardiac markers 93% 93%
Baseline cardiac markersBaseline cardiac markers DrawnDrawnPositivePositive
CK-MBCK-MB 82%82%75%75%TnT/TnITnT/TnI 99%99%91%91%
Presenting CharacteristicsPresenting Characteristics TachycardiaTachycardia 22%22%HypotensionHypotension 4% 4%Signs of CHF 23%Signs of CHF 23%
Qualifying CriteriaQualifying CriteriaST-segment depressionST-segment depression 28% 28%Transient ST-segment elevationTransient ST-segment elevation 5% 5%Positive cardiac markersPositive cardiac markers 93% 93%
Baseline cardiac markersBaseline cardiac markers DrawnDrawnPositivePositive
CK-MBCK-MB 82%82%75%75%TnT/TnITnT/TnI 99%99%91%91%
Presenting CharacteristicsPresenting Characteristics TachycardiaTachycardia 22%22%HypotensionHypotension 4% 4%Signs of CHF 23%Signs of CHF 23%
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
CRUSADE In-Hospital Outcomes : CRUSADE In-Hospital Outcomes : Last 12 MonthsLast 12 Months
Death Death 3.9% 3.9%
(Re)-Infarction (Re)-Infarction 1.8% 1.8%
CHF CHF 7.0% 7.0%
Cardiogenic Shock Cardiogenic Shock 2.2% 2.2%
Stroke Stroke 0.6% 0.6%
RBC Transfusion*RBC Transfusion* 9.4% 9.4%
*Excluding CABG-related transfusionsCRUSADE DATA: July 1, 2005 – June 30, 2006 (n= 31,665)*Excluding CABG-related transfusionsCRUSADE DATA: July 1, 2005 – June 30, 2006 (n= 31,665)
CRUSADE vs. ACS Clinical Trials:CRUSADE vs. ACS Clinical Trials:Early Mortality RatesEarly Mortality Rates
0
1
2
3
4
5
6
0
1
2
3
4
5
6
PURSUITPURSUIT11 (n = 9,461)(n = 9,461)
PRISM-PLUSPRISM-PLUS22 (n = 1,915)(n = 1,915)
SYNERGYSYNERGY33
(n = 9,975)(n = 9,975)CRUSADE CRUSADE
(n = 180,842)(n = 180,842)
1.8%1.8% 1.9%1.9%1.5%1.5%
4.54.5%%
7-day mortality rate7-day mortality rate
In-hospital mortality rate
In-hospital mortality rate
1.The PURSUIT Trial Investigators. N Engl J Med 1998 2.The PRISM-PLUS Study Investigators. N Engl J Med 19983. The Synergy Study JAMA 2004 CRUSADE cumulative data through 6/30/2006
1.The PURSUIT Trial Investigators. N Engl J Med 1998 2.The PRISM-PLUS Study Investigators. N Engl J Med 19983. The Synergy Study JAMA 2004 CRUSADE cumulative data through 6/30/2006
Goal for CRUSADE: Goal for CRUSADE: Improve Adherence to ACC/AHA GuidelinesImprove Adherence to ACC/AHA Guidelines
AspirinAspirin ClopidogrelClopidogrel
Beta BlockerBeta Blocker
Heparin (Heparin (UFH or LMWHUFH or LMWH))
GP IIb-IIIa InhibitorGP IIb-IIIa Inhibitor Cath/PCICath/PCI
AspirinAspirin
ClopidogrelClopidogrel
Beta BlockerBeta Blocker
ACE Inhibitor ACE Inhibitor
Statin/Lipid LoweringStatin/Lipid Lowering
Smoking CessationSmoking Cessation
Cardiac RehabilitationCardiac Rehabilitation
Acute TherapyAcute TherapyAcute TherapyAcute Therapy Discharge TherapyDischarge TherapyDischarge TherapyDischarge Therapy
2002 ACC/AHA Guidelines Update
Acute Medication Use – Q2 2006Acute Medication Use – Q2 2006(Within 1st 24 hours in patients without contraindications)(Within 1st 24 hours in patients without contraindications)
Q2 2006 CRUSADE data (n=6923)Q2 2006 CRUSADE data (n=6923)
96% 92%87%
45%
60%
0%
20%
40%
60%
80%
100%
ASA Beta Blockers Heparin(LMW+UFH)
GP llb-lllaInhibitors
Clopidogrel
Acute Medication Use-Last 12 MonthsAcute Medication Use-Last 12 Months(Within 1st 24 hours in patients without contraindications)(Within 1st 24 hours in patients without contraindications)
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
96%91%
83%
46%
59%
0%
20%
40%
60%
80%
100%
ASA BetaBlockers
Heparin(LMW+UHF)
GP llb-lllaInhibitors
Clopidogrel
Leading and Lagging Hospital Leading and Lagging Hospital Quartiles: Acute Care—1Quartiles: Acute Care—1stst 24 hours 24 hours
96%87% 90%
50%
85%
66% 66%
17%
0%
20%
40%
60%
80%
100%
Aspirin Beta Blockers Heparin GP IIb-IIIa
Leading Centers
Lagging Centers
Peterson et al, ACC 2004Peterson et al, ACC 2004Cumulative CRUSADE data through September 2003Cumulative CRUSADE data through September 2003
Acute Medication Use by Gender: Acute Medication Use by Gender: Last 12 MonthsLast 12 Months
97%
61%
92%85%
50%
96%
55%
91%
80%
39%
0%
20%
40%
60%
80%
100%
Aspirin Clopidogrel BetaBlockers
Heparin GP IIb-IIIa
Male Female
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
Acute Medication Use by Age: Acute Medication Use by Age: Last 12 MonthsLast 12 Months
97%
61%
92%86%
52%
95%
53%
90%
76%
32%
0%
20%
40%
60%
80%
100%
Aspirin Clopidogrel BetaBlockers
Heparin GP IIb-IIIa
<75 75+
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
Invasive Cardiac Procedures – Q2 2006Invasive Cardiac Procedures – Q2 2006(Among Patients Without Contraindications to Cath)(Among Patients Without Contraindications to Cath)
Invasive Cardiac Procedures – Q2 2006Invasive Cardiac Procedures – Q2 2006(Among Patients Without Contraindications to Cath)(Among Patients Without Contraindications to Cath)
Q2 2006 CRUSADE Data (n=6923)
84%
68%
54%
44%
11%
0%
20%
40%
60%
80%
100%
Cath Cath<48hr
PCI PCI <48hr CABG
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
Invasive Cardiac Procedures – Last 12 MonthsInvasive Cardiac Procedures – Last 12 Months(Among Patients Without Contraindications to Cath)(Among Patients Without Contraindications to Cath)
Invasive Cardiac Procedures – Last 12 MonthsInvasive Cardiac Procedures – Last 12 Months(Among Patients Without Contraindications to Cath)(Among Patients Without Contraindications to Cath)
83%
67%
53%
38%
12%
0%
20%
40%
60%
80%
100%
Cath Cath<48hr
PCI PCI <48hr CABG
Discharge Medication Use – Q2 2006 Discharge Medication Use – Q2 2006 (In patients without contraindications)(In patients without contraindications)
*LVEF < 40%, CHF, DM, HTN# Known hyperlipidemia, TC, LDLQ2 2006 CRUSADE data (n=6923)
96% 94%
65%
90%
73%
0%
20%
40%
60%
80%
100%
120%
ASA BetaBlockers
Ace-Inhibitors*
Any LipidLoweringAgent#
Clopidogrel
*LVEF < 40%, CHF, DM, HTN# Known hyperlipidemia, TC, LDL CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
Discharge Medication Use – Last 12 Months Discharge Medication Use – Last 12 Months
(In patients without contraindications)(In patients without contraindications)
95% 93%
65%
89%
74%
0%
20%
40%
60%
80%
100%
ASA BetaBlockers
Ace-Inhibitors*
Any LipidLoweringAgent#
Clopidogrel
Leading and Lagging Leading and Lagging Hospitals Quartiles: Discharge CareHospitals Quartiles: Discharge Care
94% 91%
70%
83%
62%
80%
71%
48%
62%
38%
0%
20%
40%
60%
80%
100%
D/C ASA D/C BB D/C ACE# Statin* Clopidogrel
Leading Centers Lagging Centers
* * LVEF < 40%LVEF < 40%## Known hyperlipidemia Known hyperlipidemia Peterson et al, ACC 2004Peterson et al, ACC 2004 Cumulative CRUSADE data through September 2003Cumulative CRUSADE data through September 2003
Discharge Medication Use by Gender: Discharge Medication Use by Gender: Last 12 MonthsLast 12 Months
96% 94%
63%
86%77%
94% 92%
60%
80%70%
0%
20%
40%
60%
80%
100%
120%
Aspirin Beta Blocker AceInhibitor
Statin Clopidogrel
Male Female
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
Discharge Medication Use by Age: Discharge Medication Use by Age: Last 12 MonthsLast 12 Months
96% 93%
62%
87%77%
94% 93%
61%
77%68%
0%
20%
40%
60%
80%
100%
120%
Aspirin Beta Blocker AceInhibitor
Statin Clopidogrel
<75 75+
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
Discharge Care for Discharge Care for CABG versus PCI PatientsCABG versus PCI Patients
Dyke et al, AHA 2004
95%88%
65%
76% 73% 72%
51%
79%
92%83%
44%
62%68%
86%
0%
20%
40%
60%
80%
100%
ASA BB ACE Statins SmokeCess
Counsel
CardiacRehab
Diet Mod
PCI (n=25,653) CABG (n=7663)
95%88%
65%
76% 73% 72%
51%
79%
92%83%
44%
62%68%
86%
0%
20%
40%
60%
80%
100%
ASA BB ACE Statins SmokeCess
Counsel
CardiacRehab
Diet Mod
PCI (n=25,653) CABG (n=7663)
Discharge Interventions – Q2 2006Discharge Interventions – Q2 2006
Q2 2006 CRUSADE data (n=6923)
69%
85%
64%
90%
0%
20%
40%
60%
80%
100%
Lipid Panel DietaryCounseling
CardiacRehab
Referral
SmokingCessation
Counseling
Discharge Interventions-Discharge Interventions-Last 12 MonthsLast 12 Months
CRUSADE DATA: July 1, 2005 – June 30, 2006 (n=31,665)
69%
85%
66%
89%
0%
20%
40%
60%
80%
100%
Lipid PanelDrawn
DietaryCounseling
CardiacRehab
Referral
SmokingCessation
Counseling
Treatment by Renal Insufficiency Treatment by Renal Insufficiency
Han et al, AHA 2004
78.5%
37.4%42.8%
83.7%
52.3%
30.1%
12.8%
92.6%
6.9%10.8%
23.4%
76.7%
33.8%
19.6%
77.8%
89.3%
0%
20%
40%
60%
80%
100%
No RI (n=38,783) RI (n=6,560)
78.5%
37.4%42.8%
83.7%
52.3%
30.1%
12.8%
92.6%
6.9%10.8%
23.4%
76.7%
33.8%
19.6%
77.8%
89.3%
0%
20%
40%
60%
80%
100%
No RI (n=38,783) RI (n=6,560)
Outcomes by Renal InsufficiencyOutcomes by Renal Insufficiency
Han et al, AHA 2004
3.6% 2.7% 2.3%
8.1%
12.9%
27.4%
38.6%
46.9%
16.5%
24.7%
0%
10%
20%
30%
40%
50%
Death Reinfarction CardiogenicShock
CHF Transfusion
No RI (n=38,783) RI (n=6,560)
3.6% 2.7% 2.3%
8.1%
12.9%
27.4%
38.6%
46.9%
16.5%
24.7%
0%
10%
20%
30%
40%
50%
Death Reinfarction CardiogenicShock
CHF Transfusion
No RI (n=38,783) RI (n=6,560)
Trends in Acute Therapy AdherenceTrends in Acute Therapy Adherence
Quarter 3, 2005 through Quarter 2, 2006
96%90%
84%
46%
97% 93%88%
50%
0%
25%
50%
75%
100%
Antiplatelet Beta Blocker Heparin GP IIb- IIIaInhibitor
Q3-05 Q4-05 Q1-06 Q2-06
Trends in Discharge Therapy Trends in Discharge Therapy AdherenceAdherence
94%
72%
91%
64%
89%
74%
94%
66%
88%95%
0%
25%
50%
75%
100%
Aspirin Clopidogrel Beta Blocker ACEInhibitor
Lipid-Lowering
Agent
Q3-05 Q4-05 Q1-06 Q2-06
Quarter 3, 2005 through Quarter 2, 2006
Trends in Discharge Recommendations Trends in Discharge Recommendations AdherenceAdherence
84%81%
62%
84%
62%
92%
0%
25%
50%
75%
100%
Smoking CessationCounseling
Dietary Modification Cardiac RehabilitationReferral
Q3-05 Q4-05 Q1-06 Q2-06
Quarter 3, 2005 through Quarter 2, 2006
Composite Adherence Trends Over TimeComposite Adherence Trends Over Time Quarter 1, 2002 – Quarter 2, 2006Quarter 1, 2002 – Quarter 2, 2006
0%
20%
40%
60%
80%
100%
Q1'02
Q1'03
Q1'04
Q1'05
Q2'06
Acute
Discharge
0%
20%
40%
60%
80%
100%
Q1'02
Q1'03
Q1'04
Q1'05
Q2'06
Acute
Discharge
Overall Adherence Trends Over Time Overall Adherence Trends Over Time Quarter 1, 2002 – Quarter 2, 2006Quarter 1, 2002 – Quarter 2, 2006
68.1%73.0%
78.0%80.8% 83.2%
0%
25%
50%
75%
100%
Q1'02
Q1'03
Q1'04
Q1'05
Q2'06
68.1%73.0%
78.0%80.8% 83.2%
0%
25%
50%
75%
100%
Q1'02
Q1'03
Q1'04
Q1'05
Q2'06
Link Between Overall Link Between Overall Guidelines Adherence and MortalityGuidelines Adherence and Mortality
Peterson et al, ACC, 2004Cumulative CRUSADE data through September 2003
5.95
5.16 4.97
4.16
5.074.63
4.17
6.33
0
1
2
3
4
5
6
7
<=25% 25 - 50% 50 - 75% >=75%
Hospital Composite Quality Quartiles
% I
n-H
osp
Mo
rtali
ty
Adjusted Unadjusted
5.95
5.16 4.97
4.16
5.074.63
4.17
6.33
0
1
2
3
4
5
6
7
<=25% 25 - 50% 50 - 75% >=75%
Hospital Composite Quality Quartiles
% I
n-H
osp
Mo
rtali
ty
Adjusted Unadjusted
SummarySummary
NSTE ACS patients treated in routine practice are NSTE ACS patients treated in routine practice are at higher risk than those enrolled in clinical at higher risk than those enrolled in clinical trials.trials.
While care better treatment gaps persist, While care better treatment gaps persist, especially in high-risk sub-groups.especially in high-risk sub-groups.
Continued QI efforts are needed to improve Continued QI efforts are needed to improve guidelines adherence and sustain evidence-guidelines adherence and sustain evidence-based care.based care.
CRUSADE Continues to EvolveCRUSADE Continues to Evolve
Continued National/Regional QI ActivitiesContinued National/Regional QI Activities
New Emphasis on Drug SafetyNew Emphasis on Drug Safety
Broad Dissemination of CRUSADE findingsBroad Dissemination of CRUSADE findings
Expansion to STEMI population (Optional)Expansion to STEMI population (Optional)
Longitudinal F/U program (Optional) Longitudinal F/U program (Optional)
Further Collaborations with Professional Further Collaborations with Professional Societies (AHA GWTG Program)Societies (AHA GWTG Program)