PINNACLE-AF registry shows early patterns for new atrial fibrillation treatments


The American College of Cardiology (ACC) has released first findings from its expanded outpatient registry, the PINNACLE registry, focusing on atrial fibrillation and including the next generation of anticoagulants.

The new platform, PINNACLE-AF, operates within the existing PINNACLE registry. This registry is the largest cardiovascular outpatient database in the USA, and is part of the ACC’s National Cardiovascular Data Registry (NCDR). NCDR is the most comprehensive, outcomes-based cardiovascular patient data registry for quality improvement in the United States.

“As new treatments for atrial fibrillation come online, assessing shifts in care patterns-and the impact of these shifts on patients-is a top clinical and research priority. We are interested to see if these new medications change the way doctors think about stroke prevention and help us close a long-standing quality gap in anticoagulation,” said William J Oetgen, senior vice president of Science and Quality at the American College of Cardiology.

It is documented in the PINNACLE registry as well as in the peer-reviewed atrial fibrillation literature that nearly half of all atrial fibrillation patients at moderate to high risk of stroke are not anti-coagulated according to current scientific guidelines. In a 2011 study, Paul S Chan and colleagues concluded anticoagulation rates of 55.1% in a population of 10,000 patients in the PINNACLE registry showed an “almost random pattern of treatment” when all clinical variables were considered.

More recent unpublished analysis from PINNACLE-AF on just over 121,000 unique atrial fibrillation patients from calendar year 2011 shows an overall anticoagulation rate just shy of 50%, a finding consistent with Chan’s earlier article. Unique to this analysis, however, is the inclusion of the novel oral anticoagulants dabigatran and rivaroxaban, which entered the market in late 2010 and late 2011 respectively. Of all anticoagulated AF patients, 12.6% were prescribed novel oral anticoagulants while 87.4% remained on warfarin.

“These data indicate to us that PINNACLE-AF is already yielding powerful clinical insights,” Oetgen said. “While this is at an admittedly early stage, we are exploring the hypothesis that novel oral anticoagulants appear to most often be used as an alternative to warfarin in patients already treated or likely to be treated, rather than as an option for patients previously not anti-coagulated for stroke prevention.” The PINNACLE registry Research and Publications sub-committee is currently analysing these data in preparation for a manuscript that will be submitted for peer review.

PINNACLE currently has 4.7 million patient records representing valid patient encounters from hundreds of outpatient practices nationwide. Of those patients, over 250,000 have atrial fibrillation. Participation in the registry is free to all cardiology practices.

To provide deeper data repository for future research and innovation, PINNACLE-AF also includes data elements related to kidney function and bleeding risk and events. Distribution of detailed PINNACLE-AF reports to participating providers will begin in the third quarter of 2012.