Du Xin, Patel Anushka, Li Xian, Wu Yangfeng, Turnbull Fiona, Gao Runlin
Beijing Anzhen Hospital, Capital Medical University, Beijing, China; The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
The George Institute for Global Health, University of Sydney, Sydney, Australia.
Int J Cardiol. 2017 Aug 15;241:19-24. doi: 10.1016/j.ijcard.2017.03.090. Epub 2017 Mar 24.
Variations in care and outcomes by sex in patients with acute coronary syndrome (ACS) have been reported worldwide. The aims of this study are to describe ACS management according to sex in China and the effects of a quality improvement program in Chinese male and female ACS patients.
Clinical Pathways for Acute Coronary Syndromes - Phase 2 (CPACS-2) was a cluster randomized trial to test whether a clinical pathways-based intervention would improve ACS management in China. The study enrolled 15,141 hospitalized patients [4631 (30.6%) were women] from 75 hospitals throughout China between October 2007 and August 2010. The intervention included clinical pathway implementation and performance measurement using standardized indicators with 6 monthly audit-feedback cycles. Eight key performance indicators reflecting in hospital management of ACS were measured. After adjustment for differences in patient characteristics and comorbidities at presentation, women were significantly less likely to undergo coronary angiography when indicated (RR 0.88 [0.85 to 0.92], P<0.001), less likely to receive guideline recommended medical therapies at discharge (RR 0.94 [0.91 to 0.98], P=0.003) and more likely to be hospitalized for shorter (mean difference -0.42 [-0.73 to -0.12] days, P=0.007). However, in-hospital clinical outcomes did not differ by sex. There was no evidence of heterogeneity in the relative effects of the quality improvement initiative by sex.
Sex disparities were apparent in some key quality of care indicators for patients with suspected with ACS presenting to hospitals in China. The beneficial effect of the quality improvement program was consistent in women and men.
http://www.anzctr.org.au/default.aspx. Unique identifier: ACTRN12609000491268.
全球范围内均有报道称，急性冠状动脉综合征（ACS）患者的治疗及预后存在性别差异。本研究旨在描述中国ACS患者按性别划分的治疗情况，以及质量改进项目对中国男性和女性ACS患者的影响。
急性冠状动脉综合征临床路径 - 第二阶段（CPACS - 2）是一项整群随机试验，旨在检验基于临床路径的干预措施是否能改善中国的ACS治疗。该研究于2007年10月至2010年8月期间，纳入了中国75家医院的15141例住院患者[4631例（30.6%）为女性]。干预措施包括实施临床路径以及使用标准化指标进行绩效评估，并每6个月进行一次审核反馈循环。测量了反映ACS住院管理情况的8项关键绩效指标。在对患者特征和就诊时合并症的差异进行调整后，女性在有指征时接受冠状动脉造影的可能性显著更低（风险比0.88[0.85至0.92]，P<0.001），出院时接受指南推荐药物治疗的可能性更低（风险比0.94[0.91至0.98]，P = 0.003），且住院时间更短的可能性更高（平均差异 - 0.42[-0.73至 - 0.12]天，P = 0.007）。然而，住院临床结局并无性别差异。没有证据表明质量改进举措的相对效果存在性别异质性。
在中国，因疑似ACS而就诊的患者在一些关键护理质量指标上存在明显的性别差异。质量改进项目对男性和女性的有益效果是一致的。
http://www.anzctr.org.au/default.aspx。唯一标识符：ACTRN12609000491268。
