Performance on management strategies with Class I Recommendation and A Level of Evidence among hospitalized patients with non–ST-segment elevation acute coronary syndrome in China: Findings from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome (CCC-ACS) project - 23/05/19
on behalf of the CCC-ACS Investigators
Résumé |
Background |
This study aimed to examine hospital performance on evidence-based management strategies for non–ST-segment elevation acute coronary syndrome (NSTE-ACS) and variations across hospitals.
Methods |
Improving Care for Cardiovascular Disease in China (CCC)-ACS project is an ongoing registry and quality improvement project, with 150 tertiary hospitals recruited across China. We examined hospital performance on nine management strategies (Class I Recommendations with A Level of Evidence) based on established guidelines. We also evaluated the proportion of patients receiving defect-free care, which was defined as the care that included all the required management strategies for which the patient was eligible. The hospital-level variations in the performance were examined.
Results |
From 2014 to 2018, 28,170 NSTE-ACS patients were included. Overall, 16% of patients received defect-free care. Higher-performing metrics were statin at discharge (93%), cardiac troponin measurement (92%), dual antiplatelet therapy (DAPT) within 24 hours (90%), and DAPT at discharge (85%). These were followed by metrics of β-blocker at discharge (69%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) at discharge (59%), and risk stratification (56%). Lower-performing metrics were smoking cessation counseling (35%) and percutaneous coronary intervention (PCI) within recommended times (33%). The proportion of patients receiving defect-free care substantially varied across hospitals, ranging from 0% to 58% (Median (interquartile range):12% (7%–21%)). There were large variations across hospitals in performance on risk stratification, smoking cessation counseling, PCI within recommended times, ACEI/ARB at discharge and β-blocker at discharge.
Conclusions |
About one in six NSTE-ACS patients received defect-free care, and the performance varied across hospitals.
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| Clinical trial registry—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02306616. |
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| Declaration of interest: Dr. Gregg C. Fonarow reports consulting for Bayer, Janssen, and Novartis. Dr. Dong Zhao reports attending consulting sessions by Bayer, Pfizer, and Boehringer-Ingelheim. |
Vol 212
P. 80-90 - juin 2019 Retour au numéro
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