REACHRegistrybaselineslidekit(final).pptx
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REACHRegistrybaselineslidekit(final).pptx
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TheREACHRegistry,AnInternational,ProspectiveObservationalStudyinSubjectsatRiskofAtherothromboticEventsinanOutpatientSetting,Outline,BackgroundBurdenofDiseaseRiskofAtherothrombosisREACHRegistryBackgroundRationaleandObjectivesDesignREACHRegistryBaselineResultsHighPrevalenceofPolyvascularDiseaseUndertreatmentofPatientswithAtherothrombosisWorldwideREACHRegistryTodayandBeyondPublicationstoDateUpcomingAnalysesandDataAvailabilityParticipatingOrganizationsandScientificCommittees,Background,BurdenofDisease,Stableangina,Thrombosis,1.AdaptedfromLibbyP.Circulation2001;104:
365372.2.DrouetL.CerebrovascDis2002;13(Suppl1):
16.,UA=unstableangina;MI=myocardialinfarction;ACS=acutecoronarysyndrome;TIA=transientischemicattack,UAMIIschemicstroke/TIAVasculardeath,ACS,AtherothrombosisaGeneralizedandProgressiveDiseaseProcess1,2,Aggregationofplateletsintoathrombus,Platelets,Endothelialcells,Plateletsadheringtosubendothelialspace,Plateletthrombus,Normalplateletsinflowingblood,Plateletsadheringtodamagedendotheliumandundergoingactivation,Subendothelialspace,1.Adaptedfrom:
FergusonJJ.In:
FergusonJJ,ChronosN,HarringtonRA(Eds).AntiplateletTherapyinClinicalPractice.London:
MartinDunitz;2000:
1535.,MajorRoleofPlateletsinAtherothrombosis1,MajorManifestationsofAtherothrombosis1,1.Viles-GonzalezJF.EurHeartJ2004;25:
11971207.,Coronaryarterydisease(CAD),Cerebrovasculardisease(CerebrovascDis),Peripheralarterialdisease(PAD),29,19,13,9,7,5,0,5,10,15,20,25,30,Cardiovasculardisease*,Infectiousandparasiticdiseases,Cancer,Injuries,Pulmonarydisease,HIV/AIDS,Percentageoftotaldeathsin2002,*Ischemicheartdisease,cerebrovasculardisease,hypertensiveheartdisease,inflammatoryheartdiseaseandrheumaticheartdisease,CardiovascularDiseaseistheLeadingCauseofDeathWorldwide1,AnalysisofdatafromtheFraminghamHeartStudy:
Averageremaininglifeexpectancyformalesaged60years,Healthy,Historyofanycardiovasculardisease*,HistoryofacuteMI,Historyofstroke,1.PeetersAetal.EurHeartJ2002;23:
458466.,*Includingcoronaryheartdisease,cerebrovascularaccident,congestiveheartfailureandintermittentclaudication,0,4,8,12,16,20,Time(years),9.2years,7.7years,12.0years,AtherothrombosisSignificantlyShortensLifeExpectancy1,RiskofAtherothrombosis,Cardiovasculardisease,Cerebrovasculardisease,PAD,24.7%,3.8%,11.8%,29.9%,3.3%,7.4%,19.2%,*DatafromtheClopidogrelversusAspirininPatientsatRiskofIschemicEvents(CAPRIE)study(n=19,185)Totaldoesnotaddupbecauseofrounding,Atotalof26%ofpatientshadmanifestationsofatherothrombosisinmorethanonearterialbed,1.CoccheriS.EurHeartJ1998;19(Suppl):
227.,AtherothrombosisisOftenFoundinMoreThanOneArterialBed*1,Increasedriskversusgeneralpopulation,MI,Stroke,*Suddendeathdefinedasdeathdocumentedwithinonehourandattributedtocoronaryheartdisease(CHD)IncludesonlyfatalMIandotherCHDdeath;doesnotincludenon-fatalMI,KannelWB.JCardiovascRisk1994;1:
333339.WilterdinkJIetal.ArchNeurol1992;49:
857863.AdultTreatmentPanelII.Circulation1994;89:
13331363.CriquiMHetal.NEnglJMed1992;326:
381386.,PatientswithPreviousAtherothromboticEventsareatIncreasedRiskofFurtherEvents,1.BhattDLetal.AmHeartJ2004;140:
263268.,Increasedriskofatherothromboticevents,Independentriskfactors:
RiskFactorscanCreateHighRiskofMIandStroke,EvenWithNoHistoryofTheseEvents1,Maleaged65yearsorfemaleaged70yearsCurrentsmoking15cigarettes/dayType1or2diabetesHypercholesterolemiaDiabeticnephropathyHypertensionABI0.9ineitherlegatrestAsymptomaticcarotidstenosis70%Presenceofatleastonecarotidplaque,*Riskfactors:
hypertension;hypercholesterolemia;dyslipidemia;diabetes;smoking;leftventricularhypertrophy,1.KannelWB.HypertensRes1995;18:
181196.,0,10,20,30,40,50,60,70,0,1,2,3,4,5,6,Estimated10-yearCHDrate(%),Numberofriskfactors*,Men,Women,RiskofCHDIncreasedinPatientswithMultipleRiskFactors1,ManyRiskFactorsareEasilyIdentified1,2,1.GrundySM.AmJCardiol2001;88(Suppl):
8E11E.2.FerdinandKCetal.CurrMedResOpin2005;21:
10911097.,REACHRegistry:
Background,REACHRegistry:
RationaleandObjectives,REACHRegistry:
aGlobalObservationalStudyofaround68,000Patientsin44CountriesWhoAreatHighRiskofAtherothrombosis1,1.BhattDLetal,onbehalfoftheREACHRegistryInvestigators.JAMA2006;295
(2):
180-189.,RationaleEvaluationofatherothrombosisisstilllimitedbecauseprevioussurveyshave:
Focusedonstudyingspecificriskfactors,orsinglemanifestationsofthedisease(e.g.heartdisease)Focusedmostlyonhospitalizedorhospital-treatedpatientswithstringentinclusioncriteriaBeenconductedineitherNorthAmericaorEurope,REACHRegistry:
aGlobalObservationalStudyofaround68,000Patientsin44CountriesWhoAreatHighRiskofAtherothrombosis1,TheREACHRegistryshouldhavetheseaddedadvantages:
ThemostgloballyinclusiveandgeographicallyextensiveregistryofpatientsathighriskofheartattackandstrokeIncludesabroadspectrumofpatienttypeswithorwithoutaprevioushistoryofdiseaseProvidesdatafromarealworldsetting,reflectingdailypractice,1.BhattDLetal,onbehalfoftheREACHRegistryInvestigators.JAMA2006;295
(2):
180-189.,Primaryobjectivesare:
CompileinternationaldatasettoextendknowledgeofatherothromboticriskfactorsandischemiceventsintheoutpatientsettingProvideabetterunderstandingoftheprevalenceandclinicalconsequencesofatherothrombosisinawiderangeofpatientsfromdifferentpartsoftheworld,Importantintermediateinvestigationshaveincluded:
Assessuseofriskmanagementstrategiesand18-to24-monthoutcomesinabroadoutpatientpopulationencompassingvariousgeographicregionsandphysicianspecialties,REACHRegistry:
Objectives1,1.OhmanEMetal,onbehalfoftheREACHRegistryInvestigators.AmHeartJ2006;inpress.,ImprovingtheManagementofCardiovascularDiseaseRisk,1.PearsonTAetal.Circulation2002;106:
388391.2.DeBackerGetal.EurHeartJ2003;24:
16011610.3.AmericanDiabetesAssociation.DiabetesCare2005;28:
S4S36.4.AdultTreatmentPanelIII.NationalInstitutesofHealth,PublicationNo.02-5215,September2002.,GuidelinerecommendationsbywhichREACHRegistrypatientsarebenchmarked,REACHisthemostgeographicallyandethnicallydiverseatherothromboticpopulationyetsurveyed,providingthemostaccurateviewtodateofburdenofdiseaseandlong-termprognosisforpatientsathighriskforatherothromboticeventsWithuptofouryearsofclinicalfollow-up,theREACHRegistrywillprovidelong-terminsightsintoreal-worldeventrates,treatmentpatternsandoutcomeshelptoimproveassessmentandmanagementofstroke,heartattackandassociatedriskfactors,WhatdowehopetheREACHRegistrywillachieve?
REACHRegistry:
Design,*Timelinesareforworldwideparticipation;localtimelineswillbeshorter,REACHRegistryTimeline,Mustinclude:
SignedwritteninformedconsentPatientsaged45years,Atleastoffourcriteria,1,DocumentedcerebrovasculardiseaseIschemicstrokeorTIADocumentedcoronarydiseaseAngina,MI,angioplasty/stent/bypassDocumentedhistoricalorcurrentintermittentclaudicationassociatedwithABI0.9,Atleastatherothromboticriskfactors,3,Maleaged65yearsorfemaleaged70yearsCurrentsmoking15cigarettes/dayType1or2diabetesHypercholesterolemiaDiabeticnephropathyHypertensionABI0.9ineitherlegatrestAsymptomaticcarotidstenosis70%Presenceofatleastonecarotidplaque,REACHRegistryInclusionCriteria1,1.OhmanEMetal,onbehalfoftheREACHRegistryInvestigators.AmHeartJ2006;inpress.,REACHRegistryExclusionCriteria1,Anticipateddifficultyinpatientreturningforfollow-upvisitPatientiscurrentlyhospitalizedPatientiscurrentlyparticipatinginaclinicaltrial,1.OhmanEMetal,onbehalfoftheREACHRegistryInvestigators.AmHeartJ2006;inpress.,ParticipatingphysiciansPre-definedatstartofRegistryBasedonlocalpracticepopulationGeneralpractitioners(GPs),specialistsMainlyoffice-based,somehospitalrepresentationRepresentativeof:
LocalenvironmentCountrygeography,Howweretheyselected?
Whatistheirprofile?
1.OhmanEMetal,onbehalfoftheREACHRegistryInvestigators.AmHeartJ2006;inpress.,PhysicianSelection:
ReflectionofEachCountrysManagementofCardiovascularRisk1,PatientsRecruitmentateachsiteMaximumpersitedeterminedatlocallevel(subjecttocentralguidelines)WithinoverallRegistrytimelinesPatientinclusioncriteriaDocumentedatherothromboticdisease,orwithatleast3atherothromboticriskfactorsReal-lifesetting,Howweretheyselected?
Whatistheirprofile?
1.OhmanEMetal,onbehalfoftheREACHRegistryInvestigators.AmHeartJ2006;inpress.,PatientSelection:
PatientsFittingInclusionCriteria1,REACHRegistry:
BaselineResults,Datashownmaydifferslightlyfrompublishedabstractsowingtoasubsequentdatabaselock,AimsoftheBaselineAnalysis1,Aim:
TodeterminewhetheratherosclerosisriskfactorprevalenceandtreatmentwoulddemonstratecomparablepatternsinmanycountriesaroundtheworldConclusion:
Classiccardiovascularriskfactorsareconsistentandcommon,butarelargelyundertreatedandundercontrolledinmanyregionsoftheworld,1.BhattDLetal,onbehalfoftheREACHRegistryInvestigators.JAMA2006;295
(2):
180-189.,REACHRegistry:
ConclusionsFromBaseline,Cardiovascularriskprofilesarecommonandconsistentacrossdifferentgeographiclocationsandpatienttypes:
1TreatmentgoalsareconsistentlynotachievedinallpatienttypesworldwideEstablishedtherapiesareconsistentlyunderusedinhigh-riskpopulationsWomenareundertreateddespitecommonlyhavingmoreseveredisease2TheREACHRegistrypatientswithPADhave:
3AhighprevalenceofconcomitantdiseaseinothervascularbedsMultipleriskfactorsforatherothrombosis
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