Effect of chest pain center accreditation on timely reperfusion and in-hospital mortality for STEMI in China

Abstract

Existing studies in developing countries on the impact of chest pain center (CPC) accreditation on treatment quality have limited ability to demonstrate causal relationships. This retrospective study aims to utilize the data from national-level database and explore the impact of chest pain center certification on the treatment quality of ST-segment elevation myocardial infarction (STEMI) patients through a more appropriate method. At the hospital level, taking timely reperfusion and in-hospital mortality as outcomes, the impact was evaluated using the Counterfactual Synthetic Difference-in-Differences (CS-DID) method, a statistical technique that allows for the estimation of causal effects by comparing the differences over time between treated and non-treated groups. The results showed that CPC accreditation improved timely reperfusion of STEMI. Once a CPC was certified, without considering covariates, the timely reperfusion rate increased on average by 5.4%, the 90-min PCI rate by 7.1%, and the 30-min thrombolysis rate by 2.0% in comparison with non-accredited hospitals, and this effect shows a downward trend over time and varies between different regions. We found no evidence to confirm that CPC accreditation decreases in-hospital mortality in patients with STEMI. CPC accreditation in China has improved the timeliness of reperfusion therapy for STEMI patients. CPC accreditation and re-accreditation are crucial to maintaining high-quality care for STEMI patients.

Keywords: Accreditation; CS-DID; Chest pain center; STEMI; Timely reperfusion; Treatment quality.

Fig. 1

The procedure of including and excluding patients.

Fig. 2

Trends of four indicators in hospitals of different groups. Remarks: A, B, C and D respectively represent the trends of changes in four indicators: timely reperfusion, 90-min PCI, 30-min thrombolysis and in-hospital mortality. G2015, G2016, and G2017 respectively represent the groups that passed the certification in 2015, 2016, and 2017; Control represents the control group.

Fig. 3

Effect values of the main outcome indicators at different time points. Remarks: 1 and 2 respectively represent with covariates and without covariates. A, B, C, and D respectively represent timely reperfusion, 90-minute percutaneous coronary intervention (PCI), 30-minute thrombolysis, and in-hospital mortality. For example, “1-A” represents the effect value situation of timely reperfusion at different time points without considering covariates. Blue indicates the situation before intervention, and red indicates the situation after intervention. The horizontal coordinate “Periods” represents time points. “Periods” being 0 represents the effect of the accreditation year. “Periods” < 0 indicates the effect of years before accreditation, and “Periods” > 0 represents the effect of years after accreditation. The effect value at the time point “Periods = 0” is not included in the main analysis and subgroup analysis.

Fig. 4

Effect values of the main outcome indicators after certification in different regions. Remarks: The results of the Northeast region were not trustworthy and were left out of the figure.