The PINNACLE-AF Outpatient Registry

Interview by Jodie Elrod

Interview by Jodie Elrod

In this interview, EP Lab Digest speaks with William J. Oetgen, MD, MBA, FACC, Senior Vice President for Science and Quality of the American College of Cardiology.The Division of Science and Quality oversees the National Cardiovascular Data Registry (NCDR), which includes the PINNACLE Registry.

Tell us about the PINNACLE Registry. How many patient records does the PINNACLE Registry have in its database, and what percentage of this is currently for atrial fibrillation?

The PINNACLE Registry® is cardiology’s largest ambulatory quality improvement registry. As part of the NCDR® suite of clinical registries, the PINNACLE Registry gives clinicians credible quality measurement solutions to survive in today’s demanding health care environment.

Currently, the PINNACLE Registry has over 2.1 million patient records in its database. More than half a million records, about 24 percent of the total, are for atrial fibrillation patients. This includes both valvular and non-valvular atrial fibrillation patients. 

Describe the aim of the new module, called PINNACLE-AF. Why was there a need for a PINNACLE-AF platform?

There are a couple of reasons. First, this is a time of innovation for atrial fibrillation treatment. For the first time in approximately 50 years, new anticoagulation treatments are coming to market, potentially upturning long-established care regimes. Just recently, the FDA approved rivaroxaban (Xarelto®, Bayer/Johnson & Johnson) for stroke prevention in nonvalvular atrial fibrillation, making it the first oral direct factor Xa inhibitor to win an indication for stroke prevention. Another new compound, dabigatran (Pradaxa®, Boehringer Ingelheim), was approved last October, and yet another is on the way. Combined with wide variance in the use of anticoagulation (with warfarin) today, the scientific and clinical imperative is clear, even before taking into account new rhythm control drugs and ablation techniques for atrial fibrillation patients. PINNACLE-AF will allow the ACC and its providers to develop an important repository for scientific research, which will allow the study of evolving practice patterns. It will also inform and respond to new care guidelines. PINNACLE-AF will ensure that we keep pace with the current innovations in atrial fibrillation treatment for the benefit of providers and patients. 

How will the PINNACLE-AF platform add to the current body of knowledge on atrial fibrillation?

PINNACLE already collects patient demographic information and co-morbidities. With the addition of new medication therapies, PINNACLE-AF will provide a clear profile of the care delivered to atrial fibrillation patients, a picture unmatched in completeness by other resources such as claims records or prescribing data. 

How many institutions are currently participating in the PINNACLE Registry?

The PINNACLE Registry is one of the youngest in the NCDR suite of clinical registries, but it is growing fast. PINNACLE has doubled in size each of the past two years, and is on pace to do so again. As of Q2 2011, 827 providers from 295 data-submitting office sites across nearly 30 states were submitting data to the PINNACLE Registry, with more coming onboard on a regular basis.

Tell us about the expanded data that will be collected in PINNACLE-AF. When will PINNACLE-AF take effect?

Data element definitions, database structural changes, algorithms construction, and coding for revised performance measures are already in place. Data collection will begin in early 2012, with first national summary reports available after the first quarter of 2012. 

How does PINNACLE-AF benefit practices and providers?

Practices and providers will benefit from receiving focused performance reports, which will allow them to get credit for prescribing new medication therapies according to revised care guidelines, and by engaging with these new treatment options. 

Is there anything else you’d like to add?

PINNACLE and the other registries that make up the National Cardiovascular Data Registry provide feedback that helps physicians, practices and hospitals see how they are performing compared to guidelines and other providers. Registries allow participating facilities and medical professionals to identify and close gaps in quality of care, reduce wasteful and inefficient care variations, and implement effective, continuous quality improvement processes. Outcome-based cardiology registries also provide valuable data for studies that advance the field of cardiology, and have the potential to be the basis for an improved health payment system based on outcomes and value.

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