title: Cardiovascular Disease Performance Measures in the Outpatient Setting in India: Insights From the American College of Cardiology's PINNACLE India Quality Improvement Program (PIQIP).
abstract: BACKGROUND
  India has a growing burden of cardiovascular disease (CVD), yet data on the quality of outpatient care for patients with coronary artery disease, heart failure, and atrial fibrillation in India are very limited. We collected data on performance measures for 68 196 unique patients from 10 Indian cardiology outpatient departments from January 1, 2011, to February 5, 2014, in the American College of Cardiology's PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP). PIQIP is India's first national outpatient CVD quality-improvement program.
  
  
  RESULTS
  In the PIQIP registry, we estimated the prevalence of CVD risk factors (hypertension, diabetes, dyslipidemia, and current tobacco use) and CVD among outpatients. We examined adherence with performance measures established by the American College of Cardiology, the American Heart Association, and the American Medical Association Physician Consortium for Performance Improvement for coronary artery disease, heart failure, and atrial fibrillation. There were a total of 68 196 patients (155 953 patient encounters), with a mean age of 50.6 years (SD 18.2 years). Hypertension was present in 29.7% of patients, followed by diabetes (14.9%), current tobacco use (7.6%), and dyslipidemia (6.5%). Coronary artery disease was present in 14.8%, heart failure was noted in 4.0%, and atrial fibrillation was present in 0.5% of patients. Among eligible patients, the reported use of medications was as follows: aspirin in 48.6%, clopidogrel in 37.1%, and statin-based lipid-lowering therapy in 50.6% of patients with coronary artery disease; RAAS (renin-angiotensin-aldosterone system) antagonist in 61.9% and beta-blockers in 58.1% of patients with heart failure; and oral anticoagulants in 37.0% of patients with atrial fibrillation.
  
  
  CONCLUSIONS
  This pilot study, initiated to improve outpatient CVD care in India, presents our preliminary results and barriers to data collection and demonstrates that such an initiative is feasible in a resource-limited environment. In addition, we attempted to outline areas for further improvement in outpatient CVD care delivery in India.
authors.affiliation: Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC (Sri Ram Cardio-thoracic & Neurosciences Centre) Pvt. Ltd., New Delhi, India (A.K., R.N.K.) Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN (A.K.) Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN (A.K.).
authors.forename: Ankur
authors.initials: A
authors.lastname: Kalra
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX (Y.P., R.S.H., S.S.V.).
authors.forename: Yashashwi
authors.initials: Y
authors.lastname: Pokharel
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX (Y.P., R.S.H., S.S.V.).
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Hira
authors.affiliation: American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.).
authors.forename: Samantha
authors.initials: S
authors.lastname: Risch
authors.affiliation: American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.).
authors.forename: Veronique
authors.initials: V
authors.lastname: Vicera
authors.affiliation: American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.).
authors.forename: Qiong
authors.initials: Q
authors.lastname: Li
authors.affiliation: Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC (Sri Ram Cardio-thoracic & Neurosciences Centre) Pvt. Ltd., New Delhi, India (A.K., R.N.K.).
authors.forename: Ram N
authors.initials: RN
authors.lastname: Kalra
authors.affiliation: King Edward VII Memorial Hospital and Seth G S Medical College, Asian Heart Institute and Research Center, Mumbai, India (P.G.K.).
authors.forename: Prafulla G
authors.initials: PG
authors.lastname: Kerkar
authors.affiliation: L H Hiranandani Hospital, Mumbai, India (G.K.).
authors.forename: Ganesh
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Veterans Affairs Eastern Colorado Health Care System, Denver, CO (T.M.M.) University of Colorado School of Medicine, Denver, CO (T.M.M.) Colorado Cardiovascular Outcomes Research Consortium, Denver, CO (T.M.M.).
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.).
authors.forename: William J
authors.initials: WJ
authors.lastname: Oetgen
authors.affiliation: American College of Cardiology Foundation, Washington, DC (S.R., V.V., Q.L., W.J.O., N.G.).
authors.forename: Nathan
authors.initials: N
authors.lastname: Glusenkamp
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Stanford University School of Medicine, Palo Alto, CA (M.P.T.).
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX (Y.P., R.S.H., S.S.V.) Health Policy, Quality & Informatics Program, Michael E. DeBakey Veterans Affairs Medical Center Health Services Research and Development Center for Innovations, Houston, TX (S.S.V.).
authors.forename: Salim S
authors.initials: SS
authors.lastname: Virani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000572:American Heart Association / Q000458:organization & administration; D002309:Cardiology / Q000592:standards*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D010865:Pilot Projects; D058996:Quality Improvement; D012042:Registries / Q000706:statistics & numerical data; D014481:United States
keywords: American College of Cardiology; India; PINNACLE India Quality Improvement Project (PIQIP); Practice Innovation and Clinical Excellence (PINNACLE); performance measure; quality improvement