The document summarizes an educational activity on the NCDR-ACTION Registry, which combines data from the CRUSADE and NRMI registries on the treatment of acute coronary syndromes. It describes the features and data collection process for the NCDR-ACTION Registry, including patient presentation characteristics, medical history, in-hospital treatments, outcomes, and sample institutional reports. The faculty disclosure indicates relationships with pharmaceutical companies supporting the activity.

1. ACS Critical Pathways 2007 Teleconferences This activity is supported by an educational grant from the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership. February 14, 2007

5. The NCDR-ACTION Registry: Combining the Power and Resources of CRUSADE and NRMI Gregg C. Fonarow, MD

28. NCDR-ACTION Registry Sample Report: Guidelines Adherence Sample Report: Guidelines Adherence

29. NCDR-ACTION Registry Sample Report: Discharge Therapies Sample Report: Discharge Therapies

30. CRUSADE Update C an R apid Risk Stratification of U nstable Angina Patients S uppress AD verse Outcomes with E arly Implementation of the ACC/AHA Guidelines

32. CRUSADE: Trends in Acute Therapy Adherence Available at: http://www.crusadeqi.com. © 2007 Duke Clinical Research Institute. Adapted with permission. 98% 92% 89% 48% 98% 91% 87% 50% 0% 25% 50% 75% 100% Antiplatelet β - Blocker Heparin GP IIb/IIIa Inhibitor Quarter 4, 2005, through Quarter 3, 2006. Quarter 4-05 Quarter 1-06 Quarter 2-06 Quarter 3-06

33. CRUSADE Data: October 1, 2005-September 30, 2006 (n=31,613) CRUSADE: Invasive Cardiac Procedures October 1, 2005 – September 30, 2006 (n=31,613) (Among Patients Without Contraindications to Cath) Available at: http://www.crusadeqi.com. © 2007 Duke Clinical Research Institute. Adapted with permission. 84% 67% 53% 39% 12% 0% 20% 40% 60% 80% 100% Cath Cath <48 hr PCI PCI <48 hr CABG

34. CRUSADE: Trends in Discharge Therapy Adherence Quarter 4, 2005, through Quarter 3, 2006 Available at: http://www.crusadeqi.com. © 2007 Duke Clinical Research Institute. Adapted with permission. 93% 77% 93% 68% 90% 76% 93% 65% 90% 96% 0% 25% 50% 75% 100% Aspirin Clopidogrel β - Blocker ACE Inhibitor Lipid- Lowering Agent Quarter 4-05 Quarter 1-06 Quarter 2-06 Quarter 3-06

35. CRUSADE: Trends in Discharge Recommendations Adherence 89% 80% 60% 85% 64% 88% 0% 25% 50% 75% 100% Smoking Cessation Counseling Dietary Modification Cardiac Rehabilitation Referral Quarter 4, 2005, through Quarter 3, 2006. Available at: http://www.crusadeqi.com. © 2007 Duke Clinical Research Institute. Adapted with permission. Quarter 4-05 Quarter 1-06 Quarter 2-06 Quarter 3-06

36. CRUSADE: Overall Guideline Adherence Trends Over Time Available at www.crusadeqi.com © 2007 Duke Clinical Research Institute. Adapted with permission. Quarter 1 2002 Quarter 1 2003 Quarter 2 2004 Quarter 3 2005 Quarter 3 2006 68.1% 73.0% 78.3% 80.1% 83.3% 0% 25% 50% 75% 100%

37. Performance Matters! Association Between Hospital Guideline Adherence and In-Hospital Mortality in CRUSADE Adapted with permission from Peterson ED, et al. JAMA . 2006;295:1912-1920. NSTE ACS = non–ST-segment elevation ACS; NSTEMI = non–ST-segment elevation MI. 8 7 6 5 4 3 2 1 0 1 2 3 4 In-Hospital Mortality, % Hospital Composite Guideline Adherence Quartiles NSTE ACS 8 7 6 5 4 3 2 1 0 1 2 3 4 In-Hospital Mortality, % Hospital Composite Guideline Adherence Quartiles NSTEMI CRUSADE = Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines.

38. Featured Institution Albert Einstein Medical Center Philadelphia, Pennsylvania

40. Progress Checklist: Immediate Goals Circulate discharge plan and other tools to all cardiology, ED, and CV nursing staff for comments  Circulate pathways to all cardiology, ED, and CV nursing staff for comments  Develop draft pathways  Assemble team and set up meeting of working group 

41. Progress Checklist: Short-term Goals/Activities Grand rounds/conference: Cardiology/IM  Grand rounds/conference: Emergency Dept.  Grand rounds/conference: Nursing  Circulate memo  Launch critical pathways  Finalize critical pathways 

42. Progress Checklist: Long-term Goals/Activities  NRMI  AHA Get With the Guidelines  ACC National Cardiovascular Data Registry  CRUSADE  GRACE  REACH  Other Monitor data: Which registry? 

43. Question-and-Answer Session

44. Concluding Remarks Gregg C. Fonarow, MD Next Program Gregg C. Fonarow, MD Wednesday, March 14, 2007 3:00 PM Eastern Time (12:00 Noon Pacific Time) AHA Get With The Guidelines: New Guidelines, New Challenges