Initiatives

The Cardiac Working Group (CWG) Cardiac Registry was an observational study of cardiac surgery practices, patient profiles, and clinical outcomes among patients treated in selected hospitals in Pennsylvania. Unlike a randomized clinical trial in which patients are randomly assigned to receive different treatment regimens, the CWG Registry documented and evaluated clinical practice as it is performed.

PRHI researchers worked closely with clinicians and providers in developing appropriate measures, defining information needs, and developing relevant research questions. Investigations were both clinically driven and methodologically sound. The Cardiac Registry complemented randomized clinical trials, allowing all consecutively treated patients to be evaluated, rather than the specific and often narrowly defined inclusion criteria that are employed for patients enrolled in trials.

The Cardiac Registry has since confirmed the importance of four practices in improving patient outcomes:

1. adequate use of pre-operative beta blockers
2. pre-operative aspirin
3. avoidance of anemia due to blood dilution during surgery
4. use of the internal mammary artery as a harvest site

Cardiac Registry data from 2002-2005 indicate that pre-operative beta-blocker use increased by 4% and pre-operative aspirin use increased by more than 7%.  Additionally, although the patient cohort is somewhat sicker (pre-operative hypertension, cerebral vascular disease, COPD and peripheral vascular disease have all increased), regional mortality has remained steady across the three-year span.

Results from the Cardiac Registry have set an aggressive agenda for improving care practices to prevent anemia throughout the course of cardiac surgery care. These results show that current practices put the typical female patient at about 1.8 times the male risk of in-hospital death or serious complication.

Moreover, conservative estimates of the impact on the 10 CWG hospitals suggest that annually 232 in-hospital complications or deaths could be avoided with cost savings totaling about $4.6 million. By engaging the entire team of clinicians that give care before, during, and after cardiac surgery to apply existing best practices, the CWG expects to significantly reduce the risk of adverse events and narrow the gender gap on outcomes.

Process improvements based on learning from the Cardiac Registry reports and forums significantly contributed to a decrease in regional mortality and a decrease in readmissions following CABG surgery as compared to the rest of Pennsylvania. While the number of post-CABG readmissions statewide rose by 5.8%, between 1999 and 2002, regional readmissions dropped by 4.7%. Improvements resulted in 94 fewer readmissions in CABG patients in 2002 than in 1999. With the average charge for re-hospitalization after CABG surgery at $18,438, this implies a regional annual charge reduction of $1.7 million.