Rationale and design of the improving Care for Cardiovascular Disease in China (CCC) project: a national registry to improve management of atrial fibrillation

Abstract

Introduction: Inadequate management of patients with atrial fibrillation (AF) has been reported in China for anticoagulation therapy and treatment for concomitant diseases. An effective quality improvement programme has been lacking to promote the use of evidence-based treatments and improve outcome in patients with AF.

Methods and analysis: The Improving Care for Cardiovascular Disease in China-AF programme is a collaboration of the American Heart Association and the Chinese Society of Cardiology. This programme is designed to promote adherence to AF guideline recommendations and outcomes for inpatients with AF. Launched in February 2015, 150 hospitals are recruited by geographic-economic regions across 30 provinces in China. Each month, 10-20 inpatients with AF are enrolled in each hospital. A web-based data collection platform is used to collect clinical information for patients with AF, including patients' demographics, admission information, medical history, in-hospital care and outcomes, and discharge medications for managing AF. The quality improvement initiative includes monthly benchmarked reports on hospital quality, training sessions, regular webinars and recognitions of hospital quality achievement. Primary analyses will include adherence to performance measures and guidelines. To address intrahospital correlation, generalised estimating equation models will be applied. As of March 2017, 28 801 AF inpatients have been enrolled.

Ethics and dissemination: This study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. Results will be published in peer-reviewed medical journals.

Trial registration number: NCT02309398.

Keywords: atrial fibrillation; healthcare; quality improvement; registry study.

Figure 1

Distribution of hospitals for the Improving Care for Cardiovascular Disease in China-atrial fibrillation programme. Numerals on the map indicate the number of hospitals in the area. From Hao et al.¹⁸

Figure 2

Distribution of Improving Care for Cardiovascular Disease in China-atrial fibrillation composite scores of primary performance measures across hospitals from February 2015 to March 2017. The composite scores were calculated based on the six primary performance measures, using the sum of total instances when a required measure was performed (correct care provided) divided by the total number of eligible opportunities.

Figure 3

Distribution of Improving Care for Cardiovascular Disease in China-atrial fibrillation composite scores of secondary performance measures across hospitals from February 2015 to March 2017. The composite scores were calculated based on eight secondary performance measures, using the sum of total instances when a required measure was performed (correct care provided) divided by the total number of eligible opportunities.