Adherence to quality indicators for ST-elevation myocardial infarction and its relation to mortality: a hospital
Sara Bosmans1, Yasmine Sluyts1, Jonas Lysens de Oliveira E Silva-Van Acker1
1Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium.
Insights
Adherence to quality indicators for ST-elevation myocardial infarction (STEMI) networks impacts patient outcomes. Improving diagnosis-to-balloon time is crucial for reducing in-hospital mortality in STEMI care.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) requires timely and coordinated care.
- Established quality indicators (QIs) aim to optimize STEMI treatment pathways.
- Assessing network-level adherence to QIs is essential for evaluating care quality.
Purpose of the Study:
- To evaluate adherence to key quality indicators for STEMI care within hospital networks.
- To determine the relationship between QI adherence and in-hospital mortality in STEMI patients.
Main Methods:
- Retrospective analysis of 7774 STEMI patients from 32 Belgian STEMI networks (2014-2018).
- Assessed adherence to five QIs: primary PCI use, diagnosis-to-balloon (DiaTB) time, door-to-balloon (DoTB) time, P2Y12 inhibitor and statin prescription, and a composite QI score.
- Correlated QI scores with in-hospital mortality, adjusting for baseline risk (TIMI score).
Main Results:
- The median composite QI score was 6.5 out of 10.
- Significant adherence gaps were observed in timely reperfusion: DiaTB <90 min achieved in 68%, DoTB <60 min in 67%.
- Higher QI adherence was noted in networks managing more high-risk STEMI patients.
- A significant inverse correlation was found between composite QI score and in-hospital mortality (r=-0.45, P=0.013).
- Prolonged DiaTB emerged as the most significant independent predictor of adverse outcomes.
Conclusions:
- Network-level adherence to STEMI quality indicators varies, particularly concerning time-dependent metrics.
- Diagnosis-to-balloon time is a critical, prognostic quality indicator in STEMI networks.
- Continuous assessment of quality of care across the entire STEMI network is vital for improving patient outcomes.
Aims:
To assess the adherence to established quality indicators (QIs) for ST-elevation myocardial infarction (STEMI) at the hospital-network level and its relation to outcome.
Methods And Results:
The data of 7774 STEMI patients admitted to 32 STEMI networks during the period 2014-18 were extracted from the Belgian STEMI database. Five QIs [primary percutaneous coronary intervention use, diagnosis-to-balloon time (DiaTB) <90 min, door-to-balloon time (DoTB) <60 min, P2Y12 inhibitor and statin prescription at discharge, and a composite QI score ranging from 0 to 10] were correlated with in-hospital mortality adjusted for differences in baseline risk profile (TIMI risk score). The median composite QI score was 6.5 [interquartile range (IQR) 6-8]. The most important gaps in quality adherence were related to time delays: the recommended DiaTB and DoTB times across the different networks were achieved in 68% (IQR 53-71) and 67% (IQR 50-78), respectively. Quality adherence was better in networks taking care of more high-risk STEMI patients. The median in-hospital mortality among the STEMI networks was 6.4% (IQR 4.1-7.9%). There was a significant independent inverse correlation between the composite QI score and in-hospital mortality (partial correlation coefficient: -0.45, P = 0.013). Stepwise regression analysis revealed that among the individual QIs, prolonged DiaTB was the most important independent outcome predictor.
Conclusion:
Among established STEMI networks, the time delay between diagnosis and treatment was the most variable and the most relevant prognostic QI, underscoring the importance of assessing quality of care throughout the whole network.
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