Abstract 1288: The American College of Cardiology’s IC3 (Improving Continuous Cardiac Care) Program: A Report of the First 10,000+ Patients
Background: While the inpatient management of acute coronary syndromes has been described by inpatient registries, little is known about the care of outpatients with coronary artery disease (CAD). We examined the first 10,000 outpatients enrolled into the American College of Cardiology’s IC3 (Improving Continuous Cardiac Care) Program to provide initial insights into the quality of outpatient care in CAD.
Methods: IC3 is the first national, prospective office-based quality improvement program of cardiac patients designed to capture and report outpatient performance measures (PM) and provide decision support tools to optimize the quality of care delivered to these patients. We examined the patients who had CAD, defined by a prior myocardial infarction (MI), coronary revascularization, or known coronary stenosis ≥70%. Patients were individually evaluated for each PM and could be excluded for one, but retained in others.
Results: 10,142 patients were enrolled from 13 U.S. practices, of whom 5,903 (58.2%) had CAD. Other cardiovascular conditions in enrollees included atrial fibrillation, hypertension, and heart failure. Data from IC3 were feasibly collected for all 11 CAD PMs to allow for assessments of adherence. Adherence to the CAD PMs ranged from being very high in blood pressure assessment (92.7% 5410/5839) and antiplatelet therapy (88.9% 5192/5840), to very poor, including cardiac rehabilitation referral after MI (17.2% 126/734) and screening for diabetes mellitus (DM) (13.0% 588/4532). Adherence to beta-blocker therapy after MI (85.1% 981/1153), ACE/ARB therapy for left ventricular dysfunction and/or DM (71.4% 2403/3367), and annual lipid profile assessment (73.6% 4346/5903) fell between these extremes. In addition, we were able to determine that use of thienopyridine therapy after drug-eluting stent a class I recommendation was 60.1% (161/268).
Conclusions: From this first 10,000+ patient experience in the outpatient IC3 Program, we found that nearly 3 in 5 enrolled patients had CAD and all the PMs could be reliably assessed. Adherence to the CAD PMs was often suboptimal, even after accounting for exclusion criteria, suggesting substantial opportunity for improving the quality of outpatient care.