首页|Regional variations in management and outcomes of patients with acute coronary syndrome in China:Evidence from the National Chest Pain Center Program

Regional variations in management and outcomes of patients with acute coronary syndrome in China:Evidence from the National Chest Pain Center Program

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Regional variations in acute coronary syndrome(ACS)management and outcomes have been an enor-mous public health issue.However,studies have yet to explore how to reduce the variations.The National Chest Pain Center Program(NCPCP)is the first nationwide,hospital-based,comprehensive,con-tinuous quality improvement program for improving the quality of care in patients with ACS in China.We evaluated the association of NCPCP and regional variations in ACS healthcare using generalized linear mixed models and interaction analysis.Patients in the Western region had longer onset-to-first medical contact(FMC)time and time stay in non-percutaneous coronary intervention(PCI)hospitals,lower rates of PCI for ST-elevation myocardial infarction(STEMI)patients,and higher rates of medication usage.Patients in Central regions had relatively lower in-hospital mortality and in-hospital heart failure rates.Differences in the door-to-balloon time(DtoB)and in-hospital mortality between Western and Eastern regions were less after accreditation(β=-8.82,95％confidence interval(CI)-14.61 to-3.03;OR=0.79,95％CI 0.70 to 0.91).Similar results were found in differences in DtoB time,primary PCI rate for STEMI between Central and Eastern regions.The differences in PCI for higher-risk non-ST-segment elevation acute coronary syndrome(NSTE-ACS)patients among different regions had been smaller.Additionally,the differences in medication use between Eastern and Western regions were higher after accreditation.Regional variations remained high in this large cohort of patients with ACS from hospitals participating in the NCPCP in China.More comprehensive interventions and hospital internal system optimizations are needed to further reduce regional variations in the management and outcomes of patients with ACS.

Acute coronary syndromesQuality improvementRegional variationsQuality metrics

Shuduo Zhou、Yan Zhang、Xuejie Dong、Junxiong Ma、Na Li、Hong Shi、Sidney C.Smith Jr、Yinzi Jin、Ming Xu、Dingcheng Xiang、Zhi-Jie Zheng、Yong Huo

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Department of Global Health,Peking University School of Public Health,Beijing 100191,China

Institute for Global Health and Development,Peking University,Beijing 100871,China

Department of Cardiology,Peking University First Hospital,Beijing 100034,China

Chinese Medical Association,Beijing 100052,China

Division of Cardiovascular Medicine,School of Medicine,University of North Carolina at Chapel Hill,North Carolina 27599-3140,USA

Department of Cardiology,General Hospital of Southern Theater Command of PLA,Guangzhou 510010,China

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China Medical Board(CMB)Competition Program(2020)

20-376

2024

10.1016/j.scib.2024.03.010

科学通报(英文版)
中国科学院

科学通报(英文版)

CSTPCD
ISSN：1001-6538
年,卷(期)：2024.69(9)
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