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Methods Papers

A Call to ACTION (Acute Coronary Treatment and Intervention Outcomes Network)

A National Effort to Promote Timely Clinical Feedback and Support Continuous Quality Improvement for Acute Myocardial Infarction

Eric D. Peterson, MD, MPH; Matthew T. Roe, MD, MHS; John S. Rumsfeld, MD, PhD; Richard E. Shaw, PhD; Ralph G. Brindis, MD, MPH; Gregg C. Fonarow, MD and Christopher P. Cannon, MD

From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.D.P., M.T.R.); the Veterans Affairs Medical Center, Denver, Colo (J.S.R.); the Christiana Health Care System, Newark, Del (R.E.S.); Northern California Kaiser Permanente, San Francisco, Calif (R.G.B.); University of California, Los Angeles, Calif (G.C.F.); and Brigham and Women’s Hospital, Boston, Mass (C.P.C.).

Correspondence to Eric Peterson, MD, MPH, Duke Clinical Research Institute, 2400 Pratt St, Durham, NC 27705. E-mail peter016{at}mc.duke.edu

Background— There is a recognized need for a national unified registry to track presenting features, care, and outcomes for patients with acute myocardial infarction. To address this need, the American Heart Association’s Get With the Guidelines–Coronary Artery Disease program joined the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry to create the National Cardiovascular Data Registry ACTION–Get With the Guidelines (AR-G) in June of 2008. This article outlines the objectives, operational structure, patient population, data elements, data collection methodology, and reporting components of this landmark registry.

Methods and Results— The AR-G was launched in January of 2007. The registry is led by a team of volunteers from the American Heart Association and the American College of Cardiology, and its data coordinating center resides at the Duke Clinical Research Institute. As of December 2008, 344 US hospitals already contributed detailed clinical information on 103 890 myocardial infarction patients (inclusive of 39% ST-segment myocardial infarction and 61% non–ST-segment myocardial infarction patients). Overall data quality has been excellent, with <5% clinical fields missing. Site quality improvement efforts are supported via detailed quarterly feedback reports, routine web educational programs, and sharing of "best practice" clinical support tools.

Conclusions— The AR-G represents a unified, national, acute myocardial infarction registry and supports a robust quality improvement effort designed to encourage evidence-based acute myocardial infarction care and, ultimately, improve patient outcomes.

Key Words: myocardial infarction • patients • registries

Guest Editor for this article was Véronique L. Roger, MD, MPH.

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