1. ACTION Registry (Acute Coronary Treatment and Intervention Outcomes Network) Initial Report 1st Quarter 2007 Results Report prepared by: www. ncdr.com

2. Background Recent studies have demonstrated that guidelines adherence is sub-optimal for a large proportion of ACS patients. The ACTION Registry has been created to enable hospitals to measure and improve their performance in treating patients with ACS against national benchmarks. Contained in this report are performance information from the 2006-2007 harvest from CRUSADE and the ACTION Registry.

3. The ACTION Registry Represents the merger of two of the nations premier ACS registries: –NRMI (National Registry of Myocardial Infarction) –CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC and AHA Guidelines) Unified under the leadership and support of NCDR : –Guidelines, performance indictors, and data standard alignment –Clinical/technical/contract support –Training and orientation www. ncdr.com

4. Goals of the ACTION Registry The nations ACS surveillance system –Assess characteristics, treatments, and outcomes of patients hospitalized with STEMI and NSTEMI Optimize the care and outcomes of ACS patients –Implement ALL evidence-based guideline recommendations in clinical practice –Assure that the right things are done right (safe and timely). Facilitate efforts to improve ACS care quality and safety via novel QI improvement methods

5. ACTION QI Tool Development Quarterly feedback reports Individualized GAP analysis On-line, real-time summaries QI tool kits D2B tool kits Monthly Webcasts Regional group meetings Take ACTION Campaign

6. 2006-07 Data Submission Summary Admission # of # of # of Timeframe Sites NSTEMI Records STEMI Records ACTION Jan. 1, 2007 – 227 6,917 4,259 Mar. 31, 2007 CRUSADE April 1, 2006 – 280 20,084 4,391 Dec. 31, 2006

7. ACTION Registry 2007 Patient Enrollment Number of Patients enrolled

8. Complexity of NSTEMI Pts Baseline Characteristics NSTEMI Variable (n = 26,902) Mean age ± SD (yrs) 69 ± 14 Female Diabetes mellitus Prior MI Prior CHF Prior PCI Prior CABG ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902) 40% 33% 29% 16% 23% 19%

9. Hospital Presentation Variable NSTEMI (n = 26,902) Qualifying criteria ST-segment depression Transient ST-segment elevation Presenting characteristics Tachycardia Hypotension Signs of CHF ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902) 25% 4% 22% 3% 22%

10. In-Hospital Outcomes Variable NSTEMI (n = 26,902) Death Re-infarction CHF Cardiogenic Shock Stroke RBC Transfusion* *Excluding CABG patients ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902) *Excluding CABG patients ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n=26,902) 3.8% 1.5% 6.8% 2.4% 0.7% 8.9%

11. NSTEMI Acute Medications ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007

12. NSTEMI Invasive Cardiac Procedures ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007

13. *LVEF < 40%, CHF, DM, HTN # Known hyperlipidemia, TC, LDL ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007 (n= 26,902) NSTEMI Discharge Medications % Use

14. NSTEMI Discharge Interventions ACTION/CRUSADE DATA: April 1, 2006 – May 31, 2007