Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Aug 26;11(1):62.
doi: 10.1186/s40779-024-00565-0.

Effectiveness of chest pain center accreditation on the hospital outcome of acute aortic dissection: a nationwide study in China

Li-Wei Liu #  1   2   3   4 , Yi-Kai Cui #  1   2   3   4 , Lin Zhang #  5 , Dai-Le Jia #  1   2   3   4 , Jing Wang #  6 , Jia-Wei Gu  7 , Jin-Yan Zhang  1   2   3   4 , Zhen Dong  1   2   3   4 , Xue-Juan Jin  1   2 , Xiao-Yi Zou  6 , Guo-Li Sun  8 , Yu-Xiang Dai  1   2   3   4 , Ai-Jun Sun  9   10   11   12 , Jun-Bo Ge  13   14   15   16
Affiliations
Observational Study

Effectiveness of chest pain center accreditation on the hospital outcome of acute aortic dissection: a nationwide study in China

Li-Wei Liu et al. Mil Med Res. .

Abstract

Background: The National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. The benefits of chest pain center (CPC) accreditation on acute coronary syndrome have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD).

Methods: We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016 to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis, and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions.

Results: The analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.1% vs. 16.3%, P < 0.001 and 2.9% vs. 5.4%, P < 0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.1% vs. 42.1%, P < 0.001) compared with the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR 0.644, 95% CI 0.599-0.693) and misdiagnosis (adjusted OR 0.554, 95% CI 0.493-0.624), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR 1.973, 95% CI 1.797-2.165). Following CPC accreditation, there were significant reductions in in-hospital mortality across various regions, particularly in Western regions (from 21.5 to 14.1%). Moreover, CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities (adjusted OR 0.607 vs. 0.713).

Conclusion: CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.

Keywords: Accreditation; Acute aortic dissection (AAD); Chest pain center (CPC); In-hospital outcomes.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of selection of the study population. AAD acute aortic dissection, CPC chest pain center
Fig. 2
Fig. 2
Sensitive analyses for the association between in-hospital outcomes and CPC accreditation. OR odds ratio, CI confidence interval, AAD acute aortic dissection, CPC chest pain center
See this image and copyright information in PMC

References

    1. Murphy SL, Xu J, Kochanek KD, Arias E, Tejada-Vera B. Deaths: final data for 2018. Natl Vital Stat Rep. 2021;69(13):1–83. - PubMed
    1. Wang SW, Huang YB, Huang JW, Chiu CC, Lai WT, Chen CY. Epidemiology, clinical features, and prescribing patterns of aortic aneurysm in Asian population from 2005 to 2011. Medicine (Baltimore). 2015;94(41):e1716. 10.1097/MD.0000000000001716 - DOI - PMC - PubMed
    1. Bossone E, Corteville DC, Harris KM, Suzuki T, Fattori R, Hutchison S, et al. Stroke and outcomes in patients with acute type a aortic dissection. Circulation. 2013;128(11 Suppl 1):S175–9. - PubMed
    1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the American heart association. Circulation. 2017;135(10):e146-603. 10.1161/CIR.0000000000000485 - DOI - PMC - PubMed
    1. Carrel T, Sundt TM 3rd, von Kodolitsch Y, Czerny M. Acute aortic dissection. Lancet. 2023;401(10378):773–88. 10.1016/S0140-6736(22)01970-5 - DOI - PubMed

Publication types

LinkOut - more resources