286 Clinical impact and use of a registry of practices: experience of the RICO registry of the Côte d'Or (France)

The RICO registry of the Cote d9Or (France), created in 2001, now counts almost 8000 patients hospitalised for ACS in six cardiology centres. It covers a region of 500 000 inhabitants. Can the use of a registry lead to a reduction in morbi-mortality due to myocardial infarction? Two examples to illustrate two effective uses that can improve patient management: Example 1: The analysis of 1002 patients with MI followed by the RICO registry made it possible: to show that « Only 50% of patients with MI had normal blood glucose levels, and that for one diabetic patient in three the cardiologist was unaware of the patient9s diabetes. In these patients, it was found that beta-blockers and thrombolysis were underused. At 1 year after discharge from hospital, almost half of the diabetic patients were not receiving treatment for control of their glycaemia, and that treatments for their cardiovascular condition were underused. As a result, in diabetic patients, cardiovascular mortality and the incidence of heart failure were significantly higher » to implement approaches to improve management: in particular informing emergency care teams, interventional cardiologists and cardiologists in charge of Intensive Care Units about screening and treatments for abnormal glycaemia in the acute phase and orienting screened patients towards organised care systems. to measure the impact in terms of morbi-mortality: significant increase in the proportion of patients presenting with hyperglycemia in the acute phase who received insulin therapy during the acute phase (more than 60% in 2008–2009 compared with less than 20% in 2006–2007). The impact of this approach on cardiovascular mortality will be available at the symposium. Example 2: The themes of clinical research associated with the registry have also led to improved management of patients with myocardial infarction. In a large cohort of 3291 consecutive MI patients included between the 1st January 2001 and the 31st December 2006, our data underline the impact and interest of measuring levels of NT-proBNP. Indeed: (1) NT-pro-BNP is an independent predictor of death at 1 year whatever the age group (2) NT-proBNP can therefore be used in clinical practice to stratify risk in elderly post-infarction patients. However, the relevance of NT-pro-BNP in elderly and very elderly patients with heart failure remains controversial. (3) The clinical impact of the marker lies in the fact that it can lead to improved pharmacological management, in particular by optimisation of titration for beta-blockers and angiotensin-converting enzyme inhibitors, therefore reducing mortality at 30 days and at 1 year (4). These results will be available at the symposium. Discussion/Conclusions The creation of a continuous registry of clinical practices has resulted in: an immediate benefit for patients managed in the speciality whose practises are recorded, followed and analysed by the registry team. a benefit in the medium term with the development of interventions and/or research topics derived from analysis of practices in real life. Le registre de Cote d9Or (RICO), mis en place en 2001, compte aujourd9hui pres de 8000 patients hospitalises pour SCA dans 6 centres de cardiologie. Il couvre une region de 500 000 habitants. L9utilisation d9un registre permet-elle de reduire la morbi-mortalite par infarctus du myocarde? Deux exemples pour illustrer deux utilisations efficaces pour ameliorer les prises en charge: Exemple 1: L9analyse de 1002 patients ayant eu un IDM suivis dans le registre RICO a permis: de faire un constat « Seulement un patient sur deux est normoglycemique au cours d9un infarctus et un diabetique avere sur trois n9est pas reconnu par le cardiologue. Chez ces patients, on releve un sous-emploi des betabloquants et de la thrombolyse. A 1 an apres la sortie de l9hopital, pres de la moitie des diabetiques ne recoivent pas de traitement a visee glycemique, tandis que les traitements a visee cardiovasculaire sont sous-utilises. En consequence, la mortalite cardiovasculaire et la frequence de l9insuffisance cardiaque sont significativement plus elevees chez les diabetiques » de mettre en place des demarches d9amelioration: en particulier sensibiliser les urgentistes mais egalement les cardiologues interventionnels ou les cardiologues responsables des Unites de soins intensifs au depistage mais egalement aux traitements des anomalies glycemiques en phase aigue et orienter les patients depistes dans un circuit de soins organise d9en mesurer l9impact en terme de morbi-mortalite: augmentation significative du taux de patients presentant une hyperglycemie a la phase aigue recevant une insulinotherapie a la phase aigue (plus de 60% en 2008- 2009 contre moins de 20% en 2006-2007). L9impact de cette demarche sur la mortalite cardiovasculaire sera disponible lors du symposium. Exemple 2: Les axes de recherche clinique associes au registre permettent egalement d9ameliorer l9optimisation de la prise en charge des patients presentant un infarctus du myocarde. Ainsi, sur une importante cohorte de 3291 patients consecutifs AMI, inclus entre le 1er Janvier 2001 et le 31 Decembre 2006, nos donnees soulignent l9impact et l9interet d9un dosage de NT-ProBNP en effet: (1) le NT-pro-BNP est un facteur predictif independamment de la mortalite a 1 an quelque soit le groupe d9âge (2) le NT-proBNP peut donc etre utilise dans la pratique clinique pour la stratification du risque chez les patients âges en post-infarctus alors que sa valeur reste tres controversee chez les insuffisants cardiaques âges voir tres âges (3) l9impact clinique de ce marqueur est l9amelioration de la prise en charge pharmacologique, et en particulier l9optimisation de la titration des beta-bloquants et des inhibiteurs du systeme renine-angiotensine, et donc de la reduction de la mortalite a 30 jours et a 1 an (4) ces resultats seront disponibles pour le symposium. Discussion/Conclusions La mise en place d9un registre continu de pratiques a permis d’etablir: un benefice immediat pour les patients pris en charge dans la filiere dont les pratiques sont tracees, suivies et analysees au sein d9un registre. un benefice a moyen terme avec le developpement d9interventions et/ou axes de recherche issus de l9analyse des pratiques reelles.