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. 2022 May 1;7(5):484-491.
doi: 10.1001/jamacardio.2022.0117.

Performance of Management Strategies With Class I Recommendations Among Patients Hospitalized With ST-Segment Elevation Myocardial Infarction in China

Yongchen Hao  1 , Dong Zhao  1 , Jing Liu  1 , Jun Liu  1 , Na Yang  1 , Yong Huo  2 , Gregg C Fonarow  3 , Junbo Ge  4 , Louise Morgan  5 , Changsheng Ma  6 , Yaling Han  7 , Sidney C Smith Jr  8 ; CCC-ACS Investigators
Collaborators, Affiliations

Performance of Management Strategies With Class I Recommendations Among Patients Hospitalized With ST-Segment Elevation Myocardial Infarction in China

Yongchen Hao et al. JAMA Cardiol. .

Abstract

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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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hao reported grants from American Heart Association during the conduct of the study. Dr Zhao reported grants from American Heart Association during the conduct of the study. Dr Jing Liu reported grants from American Heart Association during the conduct of the study. Dr Jun Liu reported grants from American Heart Association during the conduct of the study. Dr Fonarow reported personal fees from Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Janssen, Medtronic, Merck, and Novartis outside the submitted work and reported being associate section editor, JAMA Cardiology. Ms Morgan reported grants from Pfizer and AstraZeneca during the conduct of the study. Dr Ma reported personal fees from Bristol Myers Squibb, Pfizer, Johnson & Johnson, Bayer, and Boehringer-Ingelheim for giving lectures outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Distribution of All-or-None Score of Patients Hospitalized With ST-Segment Elevation Myocardial Infarction Across Hospitals
The all-or-none score was defined as proportion of patients who received all of the performance measures for which the patient was eligible.
Figure 2.
Figure 2.. Distribution for Proportion of Patients With ST-Segment Elevation Myocardial Infarction With Indications Receiving Class I Recommended Therapies Across Hospitals
The whiskers indicate 1.5 × IQR; the top of the bar, 75th quantile (Q3); the bottom of the bar, 25th quantile (Q1); line inside the bar, median; diamond, mean. ACEI/ARB indicates angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; DAPT, dual antiplatelet therapy; PCI, percutaneous coronary intervention. aAmong patients receiving primary PCI. bAmong patients receiving thrombolysis.
Figure 3.
Figure 3.. Temporal Trends in Utilization of Class I Recommended Therapies During the Study Period for Patients With ST-Segment Elevation Myocardial Infarction With Indications
ACEI/ARB indicates angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; DAPT, dual antiplatelet therapy; PCI, percutaneous coronary intervention. aAmong patients receiving primary PCI.
See this image and copyright information in PMC

Comment in

References

    1. Zhou M, Wang H, Zeng X, et al. . Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;394(10204):1145-1158. doi:10.1016/S0140-6736(19)30427-1 - DOI - PMC - PubMed
    1. Yang G, Wang Y, Zeng Y, et al. . Rapid health transition in China, 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2013;381(9882):1987-2015. doi:10.1016/S0140-6736(13)61097-1 - DOI - PMC - PubMed
    1. Institute for Health Metrics and Evaluation (IHME) . GBD results tool: GHDx. Accessed November 22, 2021. http://ghdx.healthdata.org/gbd-results-tool.
    1. O’Gara PT, Kushner FG, Ascheim DD, et al. . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78-e140. doi:10.1016/j.jacc.2012.11.019 - DOI - PubMed
    1. Levine GN, Jeong YH, Goto S, et al. . Expert consensus document: World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI. Nat Rev Cardiol. 2014;11(10):597-606. doi:10.1038/nrcardio.2014.104 - DOI - PubMed

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