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The BEACON Registry. BEACON Principal Investigators: – – W. Frank Peacock, MD, FACEP – – Deepak L. Bhatt, MD, FACC Sponsor: – – Heartscape Technologies,

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Presentation on theme: "The BEACON Registry. BEACON Principal Investigators: – – W. Frank Peacock, MD, FACEP – – Deepak L. Bhatt, MD, FACC Sponsor: – – Heartscape Technologies,"— Presentation transcript:

1 The BEACON Registry

2 BEACON Principal Investigators: – – W. Frank Peacock, MD, FACEP – – Deepak L. Bhatt, MD, FACC Sponsor: – – Heartscape Technologies, Inc. Clinical Trial Management: – – C5Research Data/database & Web Site Management: – – PharmalinkFHI

3 BEACON – Executive Committee W. Frank Peacock, MD (Chairman), Cleveland Clinic Deepak L. Bhatt, MD, Cleveland Clinic Christopher P. Cannon, MD, Brigham & Women’s Hospital James Hoekstra, MD, Wake Forest University Arthur Hiller (Non-voting) CEO, Heartscape Technologies, Inc.

4 BEACON – Steering Committee W. Frank Peacock, MD (Chairman), Cleveland Clinic Deepak L. Bhatt, MD, Cleveland Clinic Christopher P. Cannon, MD, Brigham & Women’s Hospital James Hoekstra, MD, Wake Forest University Arthur Hiller, CEO, Heartscape Technologies, Inc. Deborah B. Diercks, MD, UC Davis Health System Cindy L. Grines, MD, William Beaumont Hospital Charles V. Pollack, Jr., MD, Pennsylvania Hospital Robert L. Jesse, MD, Virginia Commonwealth University E. Magnus Ohman, MD, Duke University Medical Center

5 BEACON – C5Research Susan Jasper, RN, Project Manager Marilyn Borgman, RN, Project Manager Karen Mrazeck, Project Specialist Danielle Brennan, MS, Senior Statistician Alex Fu, PhD, Assistant Professor

6 BEACON - Rationale 2% of patients seen for chest pain are quickly identified as STEMI from a standard 12-lead ECG Remaining 98% of patients undergo a battery of tests Of these, 10-15% will eventually be diagnosed as acute coronary syndrome (ACS) and admitted to the hospital The remainder will be sent home after several hours in the ED

7 ED Visits - US 130,000,000 annually 6.24 M suspected or actual cardiac 4.1 M sent home non-cardiac 50,000 MIs 3.1 M non-cardiac (50%) 10.4 M chest pain (8.0%) 1.2 M AMI (20%) 1.5 M UA (24%) 374,400 sudden death (6%)

8 The Chest Pain Pie

9 Myocardial Pain Pneumonia Pneumothorax Sickle cell Anemia Pulmonary Embolus Musculoskeletal Pain Aortic Dissection Mondor’sSyndrome Tietze’sdisease HerpesZoster Blunt Chest Trauma BreastCancer Breast Abcess ContactDermatitis GERD Boerhave’s Mallory-Weiss Mediastinitis LungCancer Anxiety Panic Attack Breast Implant Thoracic Spine Ds SubdiaphragAbcess Empyema Amniotic Fluid Embolus IVDA Pulm Infarction Asthma

10 Of all the Chest Pain coming to the ER, what do we know….. NRMI 2% CRUSADE 16% 82%

11 Pre-test odds defined: N= 10,869 8% MI rate17% ACS rate Pope JH, et al. Missed Diagnosis of Acute Cardiac Ischemia in the Emergency Department. N Engl J Med 2000;342:

12 12 lead ECG errors False Positives False Positives – BER – LBBB – LV aneurysm – Pre-excitation – Brugada syndrome – Peri/myocarditis – Pulmonary embolism – J wave of Osborne – Mimics – Subarachnoid hemorrhage – Cholecystitis – Pancreatitis – Metabolic disturbances (e.g. ↑K+) – Error – Failure to recognize nl J point limits – Lead transposition False Negatives False Negatives – Prior Q waves – Error – Ventricular aneurysm – Paced rhythm – LBBB

13 BEACON – Rationale The use of additional testing on patients may improve: – – Hospital performance and efficiency measures, and – – Provide earlier identification of the patients who would ultimately be admitted for ACS This Registry will provide an opportunity to demonstrate which diagnostic methods facilitate earlier treatment of patients

14 BEACON – Primary Objective The primary objective is to: – – assess and ultimately improve the process of care and health outcomes of patients presenting with chest pain suspected to be of cardiac origin – – This will include identifying which methods facilitate the diagnosis and risk stratification of STEMI or non-STEMI patients, including patients with occult myocardial infarction (MI) and result in a shorter time to definitive diagnosis and treatment

15 BEACON Secondary Objectives The secondary objective is to determine the impact of: – – new technologies – – practice patterns – – initiatives on: – – patient time to diagnosis – – patient time to treatment – – patient survival and overall economics  -METHYL-P-[123I]- IODOPHENYLPENTADECANOIC ACID (IODOFILTIC ACID I 123 PROCESS POC, 24/7 rest mibi D2B Coronary CTA

16 BEACON – Secondary Objectives Including: Testing/evaluation with cardiac imaging versus standard 12-lead ECG alone versus enhanced lead ECG, including 80-lead PRIME ECG ® STEMI outcomes diagnosed by various technologies Impact of various marker strategies – – Point of care testing vs. lab based strategies – – High sensitivity vs. standard assay platforms HsTn IMA MPO ST-2 Scube 1 MMX

17 BEACON – Study Design Multi-center Data Collection & Follow-up Registry Participating centers will complete a survey regarding their current cardiac marker strategies, lab platforms, accessibility to nuclear and other innovative diagnostic technology. Participating centers will have enhanced lead ECG (PRIME ECG ® ) technology available. A work station, training and 30 vests will be provided to each Site at no cost by Heartscape Technologies. Usage of the PRIME ECG ® is not required, but when it is used its impact as a new modality will be assessed. All data collected will be standard of care at each institution.

18 BEACON – Study Design Electronic Data Collection (EDC) technology will be used to assign unique patient identifiers and collect data on patients. Sites will receive quarterly reports indicating their – – enrollment – – outcomes – – key quality indicators – – rates of compliance with AHA/ACC 1A recommendations for the care of ACS patients.

19 BEACON – Study Design 30 Clinical Sites Each site will enroll at least 60 STEMI and high risk patients in Part 1a and 1b (n=1800) and Each site will enroll approximately 64 patients per month (all patients presenting with chest pain suspected to be of cardiac origin) in Part 2 (n=68,200) Total of 70,000 patients in the Registry

20 Part 1a – 30 patients without PRIME ECG ® available Part 1b – patients with PRIME ECG ® available; sites will collect data on this group of patients until they have used PRIME ECG ® on 30 patients. This group will include patients with 12-lead identified STEMI Part 2 – All patients presenting with chest pain suspected to be of cardiac origin with PRIME ECG ® available BEACON – Study Design

21 1) Positive Troponin defined by institutional standard OR 2) At least 10 minutes of chest pain within 24 hours of presentation AND any one of the following: a) ST elevation >1mm on 12 lead ECG, in any 2 anatomically contiguous leads b) New LBBB c) ST depression of at least 0.5mm on 12 lead ECG, in any 2 anatomically contiguous leads d) Age ≥ 55 BEACON – Inclusion Criteria

22 e) History of PTCA, PCI, CABG, MI or myocardial ischemia by stress test f) Receiving treatment for diabetes or hyperlipidemia g) More than 20 pack years of cigarette smoking h) Admits to cocaine usage ever THERE ARE NO EXCLUSION CRITERIA THERE ARE NO EXCLUSION CRITERIA BEACON – Inclusion Criteria cont.

23 InSpire System, password protected Access via BEACON Web Site: Data collected via chart review – – List of ICD chest pain codes – – Print out from PRIME ECG ® All information from current ED visit 30 day follow up if any information available 1 year mortality status via Social Security Death Index – date of inquiry to be 18 months after ED presentation to allow for 6 month delay in SSDI system Source document – patient’s medical record BEACON – Electronic Data Collection (EDC)

24 HIPKey – a random, secure 32 digit patient identifier Patient information used is not saved in any form, it is consumed HIPKey generated from: – – Last name – – First name – – Gender – – Date of Birth – – Last 4 digits of SSN – – Country BEACON – EDC HIPKey

25 Patient demographics Emergency Department arrival date & time Hospital discharge date Number of hospital days – – ICU or Telemetry – – Non-ICU Telemetry – – “Day” defined as where patient is at midnight BEACON – Electronic Data Collection

26 BEACON – EDC Demographics

27 BEACON – EDC Arrival/Discharge

28 Signs & symptoms Vital Signs Cardiopulmonary Exam Medical History ED Laboratory Assessments (whatever is available) – – TroponinHct – – CK-MBINR – – BNPLipids – – CreatinineHgbA1c BEACON – Electronic Data Collection

29 BEACON – EDC Signs & Symptoms

30 BEACON – EDC Cardiopulmonary Exam

31 BEACON – EDC Medical History

32 BEACON – EDC Laboratory Tests

33 12-Lead ECG Augmented Lead ECG Right side ECG PRIME ECG ® Concurrent Medications BEACON – Electronic Data Collections

34 12-Lead ECG – – Data from routine report PRIME ECG® – – Data from routine report BEACON – ECG data

35 BEACON – EDC ECG

36 BEACON – EDC ECG cont.

37 BEACON – EDC PRIME ECG ®

38 BEACON – EDC PRIME ECG ® cont.

39 BEACON – EDC Concurrent Medications

40 Emergency Department Disposition Decision – – Date & Time – – Location – – Definition of Disposition Time: – – the time that the decision is made about what to do with the patient: – – the time physician writes order for cardiac cath OR when the cardiac cath lab is called OR – – The time physician writes order for admission OR when admitting office is called OR – – the time the patient is discharged from the ED BEACON – Electronic Data Collection

41 Emergency Department Discharge Diagnosis – – Date & Time Observation Unit Discharge Diagnosis Final Hospital Discharge Diagnosis BEACON – Electronic Data Collection

42 BEACON – EDC ED Disposition Decision

43 BEACON – EDC ED Discharge Diagnosis

44 Echocardiogram SPECT Coronary CT Cardiac Catheterization Mortality Status – 1 year from ED presentation BEACON – Electronic Data Collection

45 BEACON – EDC Imaging

46 BEACON – EDC Coronary CT

47 BEACON – EDC Cardiac Catheterization

48 BEACON – EDC Mortality Status

49 BEACON – Primary Endpoint Time to definitive diagnosis of: – – STEMI – – UA/NSTEMI – – Non-cardiac chest pain Time to disposition decision will be used as an objective measure of time to definitive diagnosis.

50 BEACON – Primary Endpoint Time to disposition decision: STEMI - the time of ED admission to the time physician writes order for cardiac cath OR when the cardiac cath lab is called UA/NSTEMI – the time of ED admission to the time the physician writes order for admission or when admitting office is called Non-cardiac chest pain – the time of ED admission to the time the patient is discharged from the ED

51 BEACON – Secondary Endpoints Quality indicators (time to treatment) Economic outcomes (LOS, cost of diagnosis, cost of treatment) Survival outcomes (during hospitalization, 30 day, 1 year)

52 BEACON – Statistical Analysis Endpoints will be described by: – – Type of diagnosis (STEMI, UA/NSTEMI, and non-cardiac chest pain) – – Diagnostic device utilized and testing procedures performed within each group – – A cost will be assigned to each test, procedure and treatment so a total relative cost can be calculated for each type of diagnosis

53 BEACON – Web Page – – Access EDC – – Protocol Training – – Contacts – – Chat Room – – Links – – Resources

54 BEACON – Benchmark Reports Quarterly reports Each site will receive CD containing their data – – Enrollment – – Key BEACON variables – – Outcomes – – JCAHO Quality measurements – – Rates of compliance with AHA/ACC 1A recommendations for the care of ACS patients

55 BEACON Please sign the Certificate of Training and – – Keep for your files – – Fax copy to Karen – – Protocol Questions? – – Call Sue or

56 Thank you

57 Flor Azul Honduras


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