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 beta-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 beta-blocker at discharge.
Conclusions About one in six NSTE-ACS patients received defect-free care, and the performance varied across hospitals.
[1]Capital Med Univ, Beijing Anzhen Hosp,Dept Epidemiol, Beijing Inst Heart Lung & Blood Vessel Dis,Key La, Beijing Municipal Key Lab Clin Epidemiol,Minist E, 2 Anzhen Rd, Beijing 100029, Peoples R China;
[2]Peking Univ, Hosp 1, Dept Cardiol, Beijing, Peoples R China;
[3]Univ N Carolina, Div Cardiol, Chapel Hill, NC 27515 USA;
[4]Fudan Univ, Zhongshan Hosp, Shanghai Inst Cardiovasc Dis, Dept Cardiol, Shanghai, Peoples R China;
[5]Capital Med Univ, Beijing Anzhen Hosp, Dept Cardiol, Beijing, Peoples R China;
[6]Gen Hosp Shenyang Mil Reg, Cardiovasc Res Inst, Shenyang, Liaoning, Peoples R China;
[7]Gen Hosp Shenyang Mil Reg, Dept Cardiol, Shenyang, Liaoning, Peoples R China;
[8]Univ Calif Los Angeles, David Geffen Sch Med, Div Cardiol, Los Angeles, CA 90095 USA;
[9]Amer Heart Assoc, Dept Int Sci, Basel, Switzerland;
[10]Amer Heart Assoc, Int Qual Improvement Dept, Dallas, TX USA
(8.0+极速模式)