Changes in process and outcome for ST elevation myocardial infarction in central China from 2011 to 2018
You Zhang1,2,3, Shan Wang1,2,3, Datun Qi1,3
1Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, Henan 451464, China.
Insights
Implementation of guideline-recommended treatments for ST-elevation myocardial infarction (STEMI) improved care processes and reduced in-hospital mortality between 2011 and 2018 in China. However, gaps remain, highlighting the need for enhanced public awareness and reperfusion strategies.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Limited data exist on ST-elevation myocardial infarction (STEMI) care quality changes during China's health system reform (2009-2020).
- This study assessed changes in STEMI care processes and outcomes in Henan province from 2011 to 2018.
Purpose of the Study:
- To evaluate the evolution of STEMI care processes and in-hospital mortality rates.
- To identify trends in the adoption of guideline-recommended treatments for STEMI patients.
- To inform future improvements in cardiovascular care delivery in China.
Main Methods:
- Comparative analysis of data from the 2011-2012 Henan STEMI survey (n=1548) and the 2016-2018 Henan STEMI registry (n=4748).
- Assessment of changes in the use of reperfusion therapies and guideline-recommended medications (aspirin, P2Y12 antagonists, beta-blockers, ACEIs/ARBs, statins).
- Analysis of in-hospital mortality rates and their association with care process changes.
Main Results:
- STEMI patients in 2016-2018 were younger with a lower proportion of women compared to 2011-2012.
- Composite use of guideline-recommended treatments significantly increased from 60.9% to 82.7% (P<0.001).
- Reperfusion therapy within 12 hours increased from 44.1% to 78.4% (P<0.001), despite a prolonged onset-to-first medical contact time.
- In-hospital mortality significantly decreased from 6.1% to 4.2% (OR: 0.67, P=0.005) after adjustment.
Conclusions:
- Gradual implementation of guideline-recommended treatments for STEMI patients between 2011 and 2018 correlated with decreased in-hospital mortality.
- Persistent gaps exist between current clinical practice and established treatment guidelines.
- Further emphasis on public awareness, reperfusion strategies, and chest pain center development is crucial for improving STEMI care in central China.
Background:
Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018.
Methods:
We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment.
Results:
STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment.
Conclusions:
Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.
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