Performance of Management Strategies With Class I Recommendations Among Patients Hospitalized With ST-Segment
Yongchen Hao1, Dong Zhao1, Jing Liu1
1Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Insights
In China, only 20% of ST-segment elevation myocardial infarction (STEMI) patients received guideline-recommended care, highlighting significant hospital variations. Quality of STEMI care improved over time but still falls short of recommended strategies.
Area of Science:
- Cardiology
- Healthcare Quality Improvement
- Public Health
Background:
- ST-segment elevation myocardial infarction (STEMI) treatment has advanced, yet its clinical application in China remains understudied.
- Understanding current practices is crucial for improving patient outcomes in China.
Purpose of the Study:
- To assess hospital performance and identify temporal trends in STEMI management across China.
- To evaluate the adherence to 9 Class I recommended management strategies in Chinese and US guidelines.
Main Methods:
- Utilized data from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project registry (November 2014 - July 2019).
- Included 57,560 STEMI hospitalizations from 143 tertiary hospitals.
- Analyzed hospital-level variations and trends in guideline-recommended care.
Main Results:
- Only 20% of STEMI patients received all 9 guideline-recommended strategies.
- Low performance rates were observed for reperfusion therapy (61.0%), β-blocker discharge (68.3%), ACEI/ARB discharge (55.1%), and smoking cessation counseling (36.5%).
- Significant hospital-level variations existed; however, quality of care showed improvement over the study period.
Conclusions:
- Current STEMI care quality in China does not consistently meet guideline recommendations.
- Substantial disparities in care quality exist among Chinese hospitals.
- Despite improvements, further efforts are needed to optimize STEMI management nationwide.
Importance:
Despite advances in the treatment of ST-segment elevation myocardial infarction (STEMI), little is known about how this evolving knowledge is applied in current clinical practice in China.
Objective:
To evaluate hospital performance and temporal trends in the management of STEMI.
Design, Setting, And Participants:
This study used data from the Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome Project, a nationwide quality improvement registry, in collaboration with the American Heart Association and the Chinese Society of Cardiology. Participants included patients with STEMI admitted to 143 tertiary hospitals across China from November 2014 to July 2019, and data were analyzed from November 2020 to December 2021.
Main Outcomes And Measures:
Levels, hospital-level variations, and trends for utilization rates of the 9 management strategies with Class I recommendations in Chinese and US guidelines.
Results:
A total of 57 560 hospitalizations with STEMI were included. Overall, 20.0% of patients received all the care according to the 9 guideline-recommended strategies. The performance rate of quality measures was low for reperfusion therapy (61.0%, 35 115/57 560 patients), β-blocker at discharge (68.3%, 37 750/55 285 patients), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker at discharge (55.1%, 2524/4578 patients), and smoking cessation counseling (36.5%, 9586/26 265 patients) among those who were eligible. Of 25 563 patients who underwent primary percutaneous coronary intervention (PCI), 66.8% underwent this procedure within 90 minutes of hospital arrival. Of 1128 patients who underwent fibrinolysis therapy, 253 (22.4%) underwent this treatment within 30 minutes of hospital arrival. Measures with high performance rates included receipt of dual antiplatelet therapy within 24 hours (95.5%, 54 263/56 848 patients) and at discharge (91.8%, 51 452/56 019 patients) and receipt of statin at discharge (93.0%, 52 214/56 141 patients) for those eligible. There was significant variation between hospitals in all-or-none score (ranging from 0 to 61.9%) and performance of individual measures. The quality of care improved during the study period, especially for reperfusion therapy, primary PCI within the first 90 minutes of hospital arrival, and smoking cessation counseling.
Conclusions And Relevance:
The quality of care for patients hospitalized with STEMI does not meet guideline-recommended strategies in China, with only 1 in 5 patients receiving all the care according to the 9 guideline-recommended strategies. Large disparities in the quality of care exist across hospitals.
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