Cardiac Performance Measure Compliance in Outpatients: The American College of Cardiology and National Cardiovascular Data Registry’s PINNACLE Program™

Performance measures identify aspects of care from clinical guidelines that improve patient outcomes and for which data can be feasibly collected and acted upon (1,2). While performance measures have been created for both the inpatient management of acute cardiac conditions and for outpatient care (3–5), only compliance with the inpatient performance measures has been rigorously studied. Inpatient registries, such as the National Cardiovascular Data Registries (NCDR®) and Get with the Guidelines™, have demonstrated improvements over time in performance measure compliance at hospital discharge (6–9). To date, however, there have been no systematic efforts to prospectively assess compliance with American College of Cardiology and American Heart Association (ACC/AHA) performance measures among outpatients. Given that the majority of cardiac patients are treated as outpatients, there is a compelling need to systematically measure the quality of care, as quantified by established performance measures, among outpatients so that potential gaps in the quality of outpatient care can be identified and addressed as targets for quality improvement. Accordingly, we examined baseline compliance rates to performance measures among outpatients with coronary artery disease (CAD), heart failure, and atrial fibrillation in the ACC’s Practice Innovation and Clinical Excellence (PINNACLE) program. The PINNACLE program, a prospective registry of outpatient care, represents an ideal data source to examine this question because it systematically captures outpatient compliance to each performance measure for these 3 cardiac conditions.