Assessing the Quality of Care for Patients With Acute Myocardial Infarction in China

Abstract

There is a wide practice gap between optimal care and actual care for patients with acute myocardial infarction (AMI) in China. Indicators of quality of care for AMI patients have already been developed by a modified Delphi process. Our aim was to assess the association between those indicators and in-hospital mortality in AMI patients. We hypothesized that an association exists between quality-of-care indicators and in-hospital mortality in AMI patients. Based on the data of 2128 AMI patients at 20 tertiary hospitals in Heilongjiang Province from January 1, 2009 to October 31, 2010, we estimated the compliance rates of indicators. Association between indicators and in-hospital mortality was assessed using hierarchical generalized linear models. Among 2128 patients, 163 (7.66%) died during their hospital stay. The compliance rates were 71.6%, 41.3%, 82.5%, 63.5%, 80.4%, 5.1%, 28.9%, and 41.2% for the use of aspirin, β-blocker, clopidogrel, angiotensin-converting enzyme inhibitor, statin, thrombolytic, percutaneous coronary intervention, and coronary angiography, respectively. Aspirin, clopidogrel, angiotensin-converting enzyme inhibitor, statin, and percutaneous coronary intervention were significantly associated with in-hospital mortality after adjustment for potential confounding factors. We found some disparities between guidelines and clinical practice for AMI patients in China and a significant association between indicators and in-hospital mortality. Our findings are potentially helpful for assessing and improving the quality of care for AMI patients in China.