Schiele François, Gale Chris P, Simon Tabassome, Fox Keith A A, Bueno Hector, Lettino Maddalena, Tubaro Marco, Puymirat Etienne, Ferrières Jean, Meneveau Nicolas, Danchin Nicolas
From the Department of Cardiology, University Hospital of Besancon, EA3920 University of Franche-Comté, France (F.S., N.M.); Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, and York Teaching Hospital NHS Foundation Trust, United Kingdom (C.P.G.); Department of Clinical Pharmacology, Unite de Recherche Clinique de l'Est Parisien, Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, France; Université Pierre et Marie Curie, Paris, France (T.S.); Centre for Cardiovascular Science, University and Royal Infirmary of Edinburgh, United Kingdom (K.A.A.F.); Centro Nacional de Investigaciones Cardiovasculares (CNIC), Cardiology Department, Hospital Universitario 12 de Octubre, and Universidad Complutense de Madrid, Spain (H.B.); Cardiovascular Department, Humanitas Research Hospital, Milan, Italy (M.L.); Department of Cardiology, Ospedale San Filippo Neri, Rome, Italy (M.T.); Assistance Publique-Hôpitaux de Paris (AP-HP); Hôpital Européen Georges Pompidou (HEGP), Department of Cardiology, Paris, France; Université Paris-Descartes, Paris, France (E.P., N.D.); and Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, France (J.F.).
Circ Cardiovasc Qual Outcomes. 2017 Jun;10(6). doi: 10.1161/CIRCOUTCOMES.116.003336.
The Acute Cardiovascular Care Association defined quality indicators (QIs) for the management of acute myocardial infarction. The application of these QIs to existing databases is appealing. It remains to be determined what the rates of implementation are, how the QIs are related to long-term survival, and whether quality categorization is possible.
The QIs were extracted from the French nationwide registries French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction (FAST-MI) 2005 (n=3670) and FAST-MI 2010 (n=4169). Implementation rates for each QI are reported for both cohorts. The composite QI was used for benchmarking, and the relationship between QIs and 3-year survival was determined using a Cox model. In FAST-MI 2010, 12 individual and 2 composite QIs could be assessed. Four QIs were not recorded in FAST-MI 2010 and 4 in 2005, either because of treatment nonavailability or because of data not recorded. The degree of implementation ranged from 12% to 89%, with higher rates in 2010 as compared with 2005. Seven individual QIs were associated with survival, and there was a significant and gradual association between survival and categories of the composite QI. Center categorization was possible in 26% to 30% of participating centers; 16 (27%) centers in 2005 and 14 (20%) in 2010 were categorized as low quality.
Twelve of 17 individual QIs could be assessed from FAST-MI 2010. The composite QI was significantly associated with 3-year survival and distinguished centers with high, average, and low quality of care.
急性心血管护理协会定义了急性心肌梗死管理的质量指标（QIs）。将这些质量指标应用于现有数据库很有吸引力。实施率是多少、质量指标与长期生存率有何关系以及是否可以进行质量分类仍有待确定。
质量指标取自法国全国性注册数据库2005年法国急性ST段抬高或非ST段抬高型心肌梗死注册研究（FAST-MI）（n = 3670）和2010年FAST-MI（n = 4169）。报告了两个队列中每个质量指标的实施率。使用综合质量指标进行基准比较，并使用Cox模型确定质量指标与3年生存率之间的关系。在2010年FAST-MI中，可以评估12个个体质量指标和2个综合质量指标。2010年FAST-MI中有4个质量指标未记录，2005年有4个未记录，原因要么是无法获得治疗，要么是数据未记录。实施程度从12%到89%不等，2010年的实施率高于2005年。7个个体质量指标与生存率相关，综合质量指标的类别与生存率之间存在显著且逐渐的关联。26%至30%的参与中心可以进行中心分类；2005年有16个（27%）中心和2010年有14个（20%）中心被归类为低质量。
从2010年FAST-MI中可以评估17个个体质量指标中的12个。综合质量指标与3年生存率显著相关，并区分了护理质量高、中、低的中心。
