Researchers use American College of Cardiology registry to improve cardiovascular care delivery in India

Despite challenges, it is feasible to collect and study the quality of outpatient cardiovascular care in a resource-limited environment like India, according to a pilot study published today in the Journal of the American Heart Association. Researchers used the American College of Cardiology's PINNACLE India Quality Improvement Program registry to examine performance measures and outline areas for further improvement in cardiovascular care delivery.

There is a growing burden of cardiovascular disease in India, but only limited data is available on the quality of outpatient care for patients with coronary artery disease, heart failure and atrial fibrillation. As the second most populous country in the world, India is experiencing an increase in the more traditional risk factors for coronary artery disease due to a rise in behavioral risk factors including tobacco use, physical inactivity and poor diet coupled with low levels of awareness, treatment and control of risk factors. Of the 68,196 patients from 10 cardiology outpatient departments included in the study, hypertension was present in nearly 30 percent followed by other risk factors including diabetes, current tobacco use and high cholesterol.

"This paper demonstrates the high potential for the American College of Cardiology and the PINNACLE Registry to partner with cardiologists and help them improve the quality of outpatient cardiovascular care across the globe," said William Oetgen, M.D., ACC executive vice president of science, education, and quality and one of the study authors.

The PINNACLE India Quality Improvement Program is the first cardiovascular disease care data-collection and reporting program implemented in the country. According to researchers, there were several unique challenges to implementing the program; including attempting to link patient data from appointment to appointment because a new outpatient record was often generated each time a patient visited an outpatient center. Data was also hand-written and not always legible.

With these challenges, a disproportionate provider to patient ratio and low levels of funding for quality improvement, physician-led initiatives for practice-based learning and improvement may have been considered unrealistic; however, this study demonstrates the feasibility of data acquisition and outlines future strategies to overcome challenges in data collection.