1. Cardiovascular Ischemic Event Rates in Outpatients With Symptomatic Atherothrombosis or Risk Factors in the United States: Insights From the REACH Registry Kim A. Eagle, Alan T. Hirsch, Robert M. Califf, Mark J. Alberts, P. Gabriel Steg, Christopher P. Cannon, Danielle M. Brennan, Deepak L. Bhatt, on behalf of the REACH Registry Investigators

2. Global REACH Registry: Study Design
Information shown may differ slightly from the published trial design owing to a subsequent protocol amendment

3. Global REACH Registry Objectives
Primary Objective:
To explore the impact of both classic and new risk factors on the prevalence of cardiovascular (CV) ischemic events among patients with, or at high risk for, atherothrombotic disease, on an international basis
Additional Aim:
Assess use of risk management strategies and 1-, 2-, 3- and 4-year outcomes in a broad outpatient population encompassing various geographic regions and physician specialties
1. Ohman EM et al, on behalf of the REACH Registry Investigators. Am Heart J 2006;151(4):786.e1-10.

4. Global REACH Registry Inclusion Criteria
Documented cerebrovascular disease Ischemic stroke or TIA
(CVD)
Documented coronary disease Angina, MI, angioplasty/ stent/bypass
(CAD)
Documented historical or current intermittent claudication associated with ABI <0.9
(PAD)
Male aged 65 years or female aged 70 years
Current smoking >15 cigarettes/day
Type 1 or 2 diabetes
Hypercholesterolemia
Diabetic nephropathy
Hypertension
ABI <0.9 in either leg at rest
Asymptomatic carotid stenosis 70%
Presence of at least one carotid plaque
Must include:
Signed
written
informed
consent
Patients aged
≥45 years
At least
of four
criteria
At least atherothrombotic
risk factors 1 3
ABI, ankle-brachial index; MI, myocardial infarction; TIA, transient ischemic attack.
1. Ohman EM et al, on behalf of the REACH Registry Investigators. Am Heart J 2006;151(4):786.e1-10.

5. Global REACH Registry Exclusion Criteria
Anticipated difficulty in patient returning for follow-up visit
Patient is currently hospitalized
Patient is currently participating in a clinical trial
1. Bhatt DL et al, on behalf of the REACH Registry Investigators. JAMA 2006;295(2):

6. Global REACH Registry Timeline
Baseline
Follow-up at 12  3 months
Follow-up at 24  3 months
Follow-up at 33  3 months
Follow-up at 45  3 months
Timing*
Dec 2003 to June 2004
From baseline time
Last follow-up March 2006
June 2006 to June 2007
June 2007 to June 2008
Required Data
Subject Data Form:
Section 1
Subject Data Form: Section 2
(progression since baseline)
Subject Data Form: Section 3
(progression since last follow-up)
Subject Data Form: Section 4
Subject Data Form: Section 5
Patient details, history and clinical examination
Regular medications
Employment status
Clinical outcomes
Vascular interventions
*Timelines are for worldwide participation; local timelines will be shorter

7. Global Physician Selection
Participating physicians
Pre-defined at start of Registry
Based on local practice population
General practitioners, specialists
Mainly office-based, some hospital representation
Representative of:
Local environment
Country geography
How were
they selected?
What is
their profile?
1. Ohman EM et al, on behalf of the REACH Registry Investigators. Am Heart J 2006;151(4):786.e1-10.

8. Main Specialty Breakdown of US Practitioner Involvement (n=1,599)
3.5%
GP or Internist
86.8%
9.7%
Cardiologist
Endocrinologist, Neurologist, Vascular Surgeon, Angioloist, Other
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

9. Global Patient Selection: Patients Fitting Inclusion Criteria
Recruitment at each site
Maximum 20 per site
Within overall Registry timelines
Patient inclusion criteria
Documented atherothrombotic disease, or with ≥ atherothrombotic risk factors
Real-life setting
How were
they selected?
What is
their profile?
1. Ohman EM et al, on behalf of the REACH Registry Investigators. Am Heart J 2006;151(4):786.e1-10.

10. REACH Registry: US Baseline Results
Data shown may differ slightly from published abstracts owing to a subsequent database lock

11. US Patient Characteristics at Baseline
% of population
Symptomatic (n=19,069)
Total
(n=25,686)
Multiple RF only
(n=6,617)
Mean age (SD), yr
70.0 (10.4)
70.3 (10.4)
69.2 (10.3)
Men
57.0
60.7
46.4
Diabetes
51.7
43.6
74.7
Hypertension
87.5
85.7
92.9
Hypercholesterolemia
82.6
80.7
87.8
Overweight (BMI ≥25, <30)
35.8
37.3
31.5
Obesity (BMI ≥30)
42.1
38.8
51.6
Former smoker
43.1
47.2
31.3
Current smoker
14.4
13.4
17.3
BMI, body mass index; RF, risk factors; SD, standard deviation.
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

12. US Vascular Disease Profile
CAD only (62%)
CAD + CVD (11%)
CVD only (15%)
CVD + PAD (1%)
PAD only (4%)
PAD + CAD (6%)
CAD + CVD + PAD (2%)
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

13. US Risk Factor Prevalence by Vascular Disease (%)
CAD population
88.1
88.0
85.7
84.2
CVD population
79.1
PAD population
71.8
52.7
Patients (%)
44.1
44.4
39.8
35.8
35.2
21.4
14.3
12.5
Treated
Treated Hyper-
Treated
Diabetes
Obesity (BMI ≥30)
Current
Smoker
Hypertension
cholesterolemia
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

14. US Medication Use at Baseline
% of population
Symptomatic (n=19,069)
Total
(n=25,686)
Multiple RF only
(n=6,617)
≥1 Antihypertensive Agent
93.9
93.7
94.5
≥1 Antiplatelet Agent
76.5
81.7
61.6
Any Antithrombotic Agent
85.1
91.3
66.9
≥1 Antidiabetic Agent
47.0
38.9
70.6
≥1 Lipid-Lowering Agent
83.9
82.8
86.9
Nitrates/Other Antiaginals
18.7
24.2
2.6
Claudication Medications
5.1
6.2
1.9
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

15. US Medication Use by Vascular Disease (%)
CAD population
CVD population
PAD population
94.8
92.5
93.1
91.8
91.9
90.0
86.4
83.2
80.9
81.6
77.7
73.5
Patients (%)
47.9
39.3
39.4
≥1 Antihyper-
tensive Agent
≥1 Antiplatelet
Agent
Any Antithrom-
botic Agent
≥1 Antidiabetic
Agent
≥1 Lipid-Lowering
Agent
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

16. REACH Registry: US One-Year Follow-up Analysis
Data shown may differ slightly from published abstracts owing to a subsequent database lock

17. Cumulative Event Rates for the US REACH Population
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

18. One-Year Outcomes for the US REACH Population
15.4
12.8
13.1
10.7
6.6
5.1
4.3
5.0
2.3
2.9
2.6
1.8
1.7
1.6
1.6
1.4
1.5
1.3
1.1
0.8
0.6
All values are adjusted for age and sex.
Error bars represent 95% confidence intervals.
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

19. One-Year Outcomes for the US REACH Population by Vascular Disease
All values are adjusted for age and sex.
Error bars represent 95% confidence intervals.
25.8
23.0
20.5
21.1
17.2
18.1
11.9
9.7
14.2
9.9
11.8
10.9
12.2
8.6
5.0
8.1
6.1
6.5
6.8
4.0
3.0
5.5
3.0
2.2
4.0
5.0
1.6
3.3
3.0
3.7
1.1
3.3
3.7
2.6
2.8
2.3
2.3
1.5
1.9
2.5
2.3
0.7
1.7
1.3
0.7
1.5
1.4
0.7
0.8
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

20. One-Year Outcomes for the US REACH Population by Ethnic Group
All values are adjusted for age and sex.
Error bars represent 95% confidence intervals.
14.4
14.0
12.7
12.2
10.7
12.9
11.4
10.6
5.1
4.6
4.4
4.2
2.4
2.4
2.0
2.4
1.7
1.5
2.6
1.9
1.6
1.1
1.1
1.4
1.3
1.6
1.5
1.3
Eagle KA et al, on behalf of the REACH Registry Investigators. Crit Pathw Cardiol 2009;8(2):XXX-XXX.

21. Participating organizations
The REACH Registry is sponsored jointly by
and endorsed by

22. For further information on the REACH Registry go to: